Seniors will be rewarded with private duty aide services paid for when they join a Medicare Advantage Plan.

The expansion of Medicare Advantage supplemental benefits will not be available, nor easy to find. Medicare officials have touted the expansion as historic and an innovative way to keep seniors healthy and independent. Despite that enthusiasm, a full listing of the new services is not available on the web-based Medicare Plan Finder,” the government tool used by beneficiaries, counselors and insurance agents to sort through dozens of plan options.

Even if people sign up for those plans, they won’t all be eligible for all the benefits. Advantage members will need a recommendation from a health care provider in the plan’s network. Then they may need to have a certain chronic health problem, a recent hospitalization or meet other eligibility requirements. This may be a service that home health can continue to provide once the patient needs to be discharged.

Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.

Among the new benefits that some Medicare Advantage plans said they will offer are:

  • Trips to the pharmacy or fitness center in addition to doctor’s appointments for plan members, depending on where they live or their health conditions.
  • A monthly or quarterly allowance for over-the-counter pharmacy products such as cold and allergy medications, eye drops, vitamins, supplements and compression stockings.
  • House calls by doctors or other health care providers, under certain conditions.
  • A home health care aide for a limited number of hours to help with dressing, eating and other daily activities, possibly including household chores and light housekeeping.

However, plans offering these, and other services will likely have only some of the options and will have different eligibility criteria and other limitations. The same services likely won’t be available in every county the plan serves.

For example, next year an estimated 150,000 Humana Medicare Advantage members in Texas and South Florida — two of the 43 states Humana serves — who cannot be left alone at home will be able to get a free in-home personal care aide for up to 42 hours a year, so that their regular caregiver can get a break. This is about 3.5 hours a month.

Now, that may not seem like a lot, but consider this example: If I received 42 hours a year and I currently used private duty services for my loved one for 15 hours a week; that is just about 3 weeks a year of services paid for by the Medicare advantage plan. That may make me switch to a home care organization that has a contract with that Medicare advantage plan. And more than half of the members in Cigna-Health Spring Advantage plans will have access to free transportation services in all but five of the 16 states and the District of Columbia where the company sells coverage.

In addition to all the information that I just shared with you I want to add a few facts. The Medicare patient population continues to grow, by the end of this year we will have 61 million Medicare beneficiaries. In fact, our Medicare population will have grown by over 6 million in the 5 years alone.  In the next 30 years, Medicare individuals is expected to grow to 92.6 Million. Why? Beneficiaries are living longer. Women 65 years and older today have a higher life expectancy86.6 years. Men 65 years and older today have an average life expectancy of 84.3 years.

This will put continued pressure on the Medicare program as older beneficiaries are known to consume a disproportionate share of healthcare services. This is the reason that the government is pushing to get people into Medicare Advantage plans.

If you aren’t a provider of Medicare Advantage plans let me share with you this fact. As of Jan of 2019: 34% of all seniors participated in a Medicare Advantage plan, AND it is estimated that by Jan of 2020, that number will climb to over 40%.

Want to learn more? Want to figure out how to survive in this changing landscape. Join us for the Virtual Growth Summit.

 

Cheryl “The Solutionist” Peltekis, RN

About the Growth Summit:

Imagine what it would mean for your agency if you could get ahead of the competition by knowing EXACTLY how to position your agency for ALL the PAYMENT CHANGES that are about to happen! Imagine what it would mean for your agency if you don’t learn how to survive and thrive.

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