Recently, Medicare Advantage (also called Part C) health care coverage changed to cover some in-home care services. One goal of the change is to prevent complications from surgery or illness. Others are to reduce the need for emergency services and prevent a stay in the hospital.
As you consider paying for a Medicare Advantage plan, keep these things in mind about the recent changes.
Understanding Medicare Advantage
There are four types of Medicare health plans:
- Medicare Part A (hospitalization). This is free in some instances.
- Medicare Part B (outpatient services). You pay a monthly premium based on income.
- Medicare Advantage Part C (a reasonable alternative to Parts A and B). You may pay a monthly premium depending on size of plan, deductible and coverage.
- Medicare Part D (prescription drug coverage). You typically pay a monthly premium.
Medicare Advantage is a type of Medicare health plan. It is offered by private health insurance companies that contract with Medicare. These plans provide all of the benefits associated with Parts A and B (referred to as “Original Medicare”) and often (though not always) Part D.
More than 20 million people opted for Medicare Advantage plans in 2018 instead of Original Medicare plans. This is because Original Medicare plans have limitations. Medicare Advantage plans have supplemental benefits that relate to primary care. For instance, along with coverage for surgery or injury, plans may cover corrective lenses or hearing aids.
Recently, Medicare Advantage guidelines approved by the Centers for Medicare and Medicaid Services (CMS) in October 2018 now allow more flexibility that enhance quality of life. One of the changes that took effect on January 1, 2019, is coverage for home care.
How New Medicare Advantage Changes Connect to Home Care
In the past, coverage for home health services was limited to medical therapies and skilled nursing care and home care services would only be approved for coverage if provided by required skilled nursing care. Now, some plans can help you pay for home care. “Some Medicare Advantage plans will cover housekeeping services, meal delivery, and aides to help with activities of daily living such as bathing, dressing, and eating,” says Danielle K. Roberts, the co-founder of Boomer Benefits, a Medicare agency licensed in 47 states. Ride-share coverage to medical appointments and access to telehealth may also be covered.
Many of the newly covered services may be provided by a family or professional caregiver, instead of a skilled nursing provider. This benefit was designed to help people live independently in their own homes for as long as possible.
“The changes allow Medicare beneficiaries to receive benefits that will enable them to make their home safer,” says Chris Hakim, head of the Medicare Division for eHealth and eHealthMedicare. This may cover ramps for wheelchairs and hold bars. They also allow health plans to pay for services that are preventive in nature, such as healthy meals. These changes have the potential to improve the overall health and quality of life for beneficiaries and their caregivers, though benefits are generally limited to a certain number of hours of care each year.
“Medicare Advantage plans now may also pay for respite care for the first time,” adds Hakim. Respite care options that can be covered by some Medicare Advantage plans include:
- Short-term residential facilities. Many assisted living facilities, nursing homes, and hospice centers offer short-term respite care. There are typically rooms in these facilities designed for temporary stays by respite patients.
- In-home respite care. For caregivers that need a temporary break but would like their loved one to stay at home. In this case, you can hire a professional caregiver to care for your loved one while you take a break.
- Adult day care. Caregivers can schedule respite care through an adult day care on occasion or a set schedule. This is a great change of pace and scenery for the patient while giving the caregiver a temporary break.
The exact Medicare Advantage plan options you may be eligible for will vary based on the plans offered in your area. CMS reports that roughly 300 plans added one or more of the new supplemental benefits for 2019. “However, the guidelines were issued late in the year after most insurers had already released their 2019 plans. CMS expects a much larger number to offer supplemental benefits in 2020,” says Hakim.
“Ultimately, all Medicare Advantage members could have access to some, or all, of these benefits,” says Roberts. That access depends on which benefits are implemented by the health insurers offering plans in their area for 2020. Health plans determine benefits they’ll include in the coming year’s health plans by June of the current year and that information is available every July.
How Home Care Improves Quality of Life
Medicare Advantage plans recognize the importance of delivering care at the right time and in the most appropriate setting. “Hospital care, in particular, is very expensive. In many cases, people are admitted to the hospital because that is the easiest care setting for the beneficiary to access,” says Hakim.
The new Medicare Advantage rules allow plans to structure their benefits in ways that lower overall program costs. The changes also deliver care in settings that people covered by Medicare prefer.
It is also a huge boost to quality of life. “Most people wish to remain at home. Some of the new benefits also recognize the critical role of caregivers and the challenges they face in caring for loved ones,” says Hakim. The new support available is intended to offer them the assistance they need and boost their quality of life.
“The change in benefits is aimed at preventing injuries and illness as opposed to treating someone after they get injured or ill,” explains Hakim. Access to railings in the home can prevent falls, and having healthy meals delivered may prevent issues relating to dehydration or malnutrition. “These are all aimed at improving seniors’ quality of life and health,” says Hakim.
These new benefits will allow beneficiaries to stay at home longer. In some cases, it may prevent a move to assisted living or other types of care settings. That saves individuals and the health care system money.
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