- A new report says there will be dozens of new services covered under Medicare Advantage plans next year.
- Among the services are therapeutic massage, home modifications, and transportation services.
- Experts say there are advantages and disadvantages to signing up for these plans, so older adults should be well informed before choosing.
Therapeutic massage and assistance with trips to the grocery store might not sound like typical Medicare benefits, but they’re among the expanded offerings many Medicare Advantage plans will feature next year.
That’s according to a new report from actuarial consulting firm Milliman, commissioned by the Medicare Advantage advocacy group, the Better Medicare Alliance (BMA).
In the past 2 years, the Centers for Medicare and Medicaid Services (CMS) expanded the definition of what constitutes “primarily health related” benefits under Medicare Advantage plans to allow care services focused on the daily maintenance of life and not just direct acute medical treatment.
Medicare Advantage plans are private insurance plans available to people eligible for Medicare, the government-funded health insurance program that provides medical coverage for people 65 years and older.
Many of these new benefits are Special Supplemental Benefits for the Chronically Ill (SSBCI), designed to improve quality of life among Medicare Advantage enrollees with chronic illnesses.
“Plans will have the ability to offer a ‘non-primarily health related’ item or service to chronically ill enrollees if the SSBCI has a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee,” according to an agency briefing.
That’s led to an explosion of expanded benefits among Medicare Advantage plans, with 116 plans offering more than one of these services in 2020 compared to none in 2019, the Milliman report finds.
Among the permitted benefits outlined in the CMS brief were meal services, transportation for non-medical needs such as going to the grocery store or the bank, pest control, services supporting self-directed living and person-centered planning, and structural home modifications for people who are chronically ill — to name a few.
Many of these changes are the direct result of the passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which was designed to expand and improve access to integrative services under Medicare.
“These new benefits have only an upside as now providers have the ability to address other factors that are driving medical conditions, like a dysfunctional air conditioner that is making a Medicare beneficiary sick,” Shaun Greene, head of business operations at health insurance plan and comparison tool HealthPocket, told Healthline.
“It is impossible to quantify how much help these new benefits will provide but it is fair to say there is really no limit other than the creativity of the Medicare Advantage plans and providers,” he said. “The Chronic Care Act opens up so many possibilities for innovation.”
That all sounds great, which may leave people thinking: What’s the catch?
Medicare Advantage plans, which are funded by CMS, have to provide the same level of care as government-run Medicare, but they can offer different services, benefits, and levels of cost-sharing compared to standard Medicare.
“The system works somewhat like school vouchers. People can either choose to take the default, government-run option, or can use their voucher to purchase a private option,” said Adam C. Powell, PhD, a lecturer at Northeastern University in Massachusetts and the president of Payer+Provider Syndicate, a management advisory and operational consulting firm focused on the managed care and healthcare delivery industries.
“The pros and cons of a particular Medicare Advantage plan are highly dependent upon its plan design,” Powell told Healthline. “Potential benefits that some Medicare Advantage plans have include less cost-sharing than Original Medicare, prescription drug coverage, dental and vision benefits. Although benefits are typically enriched, Medicare Advantage plans may also have limitations on healthcare provider access which are not found in Original Medicare. The network of providers available within a Medicare Advantage plan may be regional, and referrals may be required to use some services.”
In other words, Medicare Advantage is all about trade-offs.
Advantage plans have an expanded menu of benefits and limit costs with yearly out-of-pocket maximums ($6,750 in-network, $10,000 out of network on a PPO in 2019), where Medicare has no maximum.
On the other hand, Advantage plans can require pre-authorization on procedures such as traditional private insurance plans do and also have defined in-network and out-of-network care.
That means Medicare Advantage plans don’t “travel” as well as standard Medicare.
“Consumers like these [Advantage] plans because they can usually be found with small or no monthly premiums. And many include Part D drug coverage as well as other ancillary benefits, including some dental and vision coverage, transportation service, nurse hotlines, and wellness benefits, meals during recovery, and some long-term care benefits,” Adam M. Hyers, founder of the health insurance agency Hyers and Associates Inc., told Healthline. “These are all great features but not reason enough to necessarily purchase a plan. You want to make sure the insurance itself fits your needs and budget in the event of an accident or illness.”
Original Medicare has no insurance middlemen for pre-authorization and offers comprehensive coverage regardless of which hospital you go to.
“On original Medicare, there is generally no one between you and your doctor determining the care you can receive,” Kathe Kline, founder of Medicare education website and San Diego Medicare brokerage MedicareQuick.com, told Healthline.
Regarding the expanded service offerings on many Medicare Advantage plans, Kline was even-handed.
“Not all plans are offering the new benefits,” she said. “Of those that are, some plans are offering only limited benefits, such as a personal safety necklace. Time will tell what new services will be offered over the next few years. The more competitive the area, the more services I expect to see offered by the plans.”