Medicare Advantage (MA) plans, also known as “Part C,” are popular alternatives to original Medicare in that these plans not only offer doctor and hospital benefits, but also additional benefits, such as dental and vision plans. In 2019, the Centers for Medicare & Medicaid Services (CMS) expanded the list of supplemental benefits that MA plans may offer. Only a small percentage of MA plans are offering these benefits in 2019, so enrollees may need to look hard to find ones that do.
Medicare Advantage Changes for 2019
The most important overall change in 2019 is that CMS now considers items and services to be supplemental benefits if they “diagnose, treat or prevent illness or injuries,” or compensate for physical impairments. CMS added that supplemental benefits may now cover services that reduce the functional and psychological impact of illnesses or injuries.
What’s not included in the new definition are items or services that serve only cosmetic purposes, or that are used to lessen the impact of the social determinants of health (such as money to access nutritious food). For patients to obtain coverage for these items and services, they must be clearly identified in a care plan that is signed by a health care professional.
Also new for 2019 are home-based palliative care benefits. These benefits are designed to reduce symptoms of terminally ill Medicare recipients who have a life expectancy of greater than six months. These services do not overlap with the hospice benefit that is already covered by MA plans.
Home healthcare receives a boost
The benefit expansion also includes in-home support services, including assistance in performance of activities of daily living, as well as services designed to reduce the functional and psychological aspects of an injury or illness. The purpose of these services is to reduce unnecessary use of emergency care. All of these services must be provided by agencies that are licensed by the various states and conform to state requirements.
The new benefits borrow a successful idea from the UK, where the National Health Service provides support for caregivers of Medicare recipients, in the form of short-term respite care, as well as counseling and training.
Medicare Advantage supplemental benefits address the opioid crisis
In response to the opioid crisis, MA supplemental benefits now include medically-approved non-opioid pain management. Pain treatments such as therapeutic massage are now covered, with the proviso that the treatments are specifically ordered by a healthcare provider and are designed to serve a health-related purpose, such as bone pain related to cancer.
Safety at home
There have been modifications as well regarding home and bathroom safety devices. Non-Medicare-covered devices such as shower stools, hand-held showerheads, rails and grab bars, raised toilet seats, and night-lights all may now be covered by supplemental benefits. The benefits even cover the costs of installation and inspection of these devices, provided a qualified health professional identifies that the Medicare recipient specifically needs the device.
Excluded from this list are capital and structural improvements. For example, the widening of a hallway would not be covered by the new supplemental benefits. Likewise, smoke detectors and fire alarms are exempt.
Transportation, memory and pill-cutters now covered
Non-emergent transportation is now covered by the benefit expansion, provided that the transportation is to a healthcare provider. Trips to the supermarket or the bank are not covered. On the other hand, funding for a health aide to assist the Medicare recipient getting in and out of a vehicle is covered.
There is also a stand-alone memory fitness benefit, designed primarily to prevent, treat and reduce the functional and psychological impacts of memory loss. These benefits had been offered previously as part of the health education benefit. Now they may be offered separately by MA plans.
There are also several over-the-counter benefits for medicines and other items that are not covered by Medicare Parts A, B or D (the pharmacy benefit). These benefits include assistive devices such as pill-cutters that had not been covered previously by Part C plans.
The future looks uncertain for 2020. We are still waiting for supplementary guidance prior to the close of 2019. Experts predict that the 2020 changes will redefine supplementary benefits from being “primarily health-related” to ones that “have a reasonable expectation of improving or maintaining health or overall functioning” of the chronically ill. This definition is not specific to any particular health condition or injury. Finally, there are hints that social determinants of health will indeed be included in the 2020 update.