Medicare Advantage Plans and Home Care in 2020

Published January 23, 2020

In September 2019, the Centers for Medicare and Medicaid (CMS) announced that premiums on 2020 Medicare Advantage (MA) plans would decrease by an average of 23 percent, compared to the 2018 average premium, while the list of covered benefits would continue to increase. The announcement was released prior to the beginning of the 2020 open enrollment period, when many seniors began choosing their coverage plans for the coming year.

MA plans are an alternative to traditional Medicare, encompassing inpatient, outpatient, and prescription drug benefits. In 2018, CMS announced that MA plans would expand to cover home-based services as well. The new plans include several new services that are available to millions of MA plan members. Since their introduction in 2010, MA plans have become increasingly popular among Medicare recipients, and the additions planned for 2020 will likely add to this enthusiasm.

More Benefits, More Providers

In addition to several new health plans entering the MA market, there will also be a dramatically larger series of covered services; 12 percent of MA plans will offer expanded supplemental benefits, which is a considerable increase from 3 percent in 2019.

In 2020, a substantial number of MA plans will offer dental, hearing, and vision plans, and even fitness benefits. While not all MA plans will offer all these benefits, in 2020 plan members will be more likely to find a plan that suits them. The number of plans available in 2020 will increase to 3,148 nationwide, which is 414 more than were available in 2019. There will be substantial geographical disparities regarding the number of plans available in a particular county; however, only one percent of beneficiaries live in counties that don’t offer MA plans. The menu of choices among MA plan sponsors is also expanding. One-quarter of all MA recipients will have 10 or more plans to choose from in 2020. Nearly all (97 percent) of the new plans will offer expanded supplemental benefits.

Population Health

Many of the expanded supplemental benefits are focused on a category of services referred to as population health. This should not be confused with “public health,” which refers generally to functions that governments provide to prevent outbreaks of infectious diseases. Rather, population health refers to categories that had not previously been classified as health benefits, including transportation to outpatient visits, assistance with meals, and support for caregivers, the result of which is overall improvement in the health of a community. The concept of population health is not very different from that of social determinants of health, which has been broadly defined as the sum total of social and environmental factors that have an impact on individual health.

Safety in the Bathroom and Bedroom

Falls in the bathroom are a substantial source of injuries and even deaths among the elderly and chronically ill. In 2020, many of the expanded supplemental benefits will include coverage for durable medical equipment designed particularly for the bathroom. These include shower stools, hand-held showerheads, rails and grab bars, and raised toilet seats. Because low-light vision declines steadily with age, many seniors are at risk of injuries from collisions and falls at night. This is why, in 2020, some MA plans will begin to cover night-lights.

Telemedicine and Telemonitoring

Some MA plans will offer benefits that take advantage of the fact that much of patient monitoring, from blood pressure to pulmonary function testing, can be performed at home, allowing the patient to avoid the time and safety risk of traveling to a physician’s office or hospital. Telemonitoring technology is improving rapidly, and the pace of this improvement is likely to accelerate with the imminent arrival of nationwide 5G networks that will turn the promise of the medical internet-of-things into a reality. Smartphone technology has advanced to the point that many MA plan recipients already own telemonitoring devices that only require appropriate downloads. Telemonitoring is also cost-effective, not only because of the savings to Medicare and to individual patients resulting from fewer office visits, but also because early detection of incipient health crises can help avert otherwise unnecessary hospitalizations.

Why Expanded Supplemental Benefits Are Likely to Succeed

As if the expansion of benefits were not already good news for seniors, it turns out that the expansion is not likely to cost them more money in the form of co-payments and co-insurance. MA plans also have maximum out-of-pocket expenses, after which the plan pays for all expenses.

The reason that this trend is likely to succeed in the long term is related to the shift in the location of healthcare delivery from the hospital to the home. That shift is driven in no small part by technology that allows care to occur remotely. Technology has already proven to be a powerful ally to the “connected nurse,” combining the benefits of face-to-face interaction with patients with connectivity to care centers and data repositories. Over time, the resulting health benefits will add years of quality life to MA plan members.