Medicare Advantage Offers New Wellness Benefits

Update – We have added the most recent updates to Medicare Advantage at the bottom of this blog post. The original blog post was published in March 2019. So if you want to read the current year benefits straight away, skip this and scroll to the bottom.

The Caring Voice Team recently spoke to Tomi Vgea who is a certified application counselor under the Affordable Care Act as determined by the Centers for Medicare and Medicaid Services to know more about some new updates with Medicare Advantage.

In case you were unaware, Medicare Advantage plans are a private add-on to the Medicare program. They are quite popular and could be a great alternative to Medicare. Today we are going to take a look at some of the new wellness benefits that could put them on par with Medicare, or may even offer better features in some cases.

In the last couple of years, there have been some great additions to the add-on that is also called Part C. Some of these are

  • An option to cover expenses like transportation or caregiver support

We don’t blame you for thinking that these added benefits are limited. They are, in fact, limited for 2019. But Tomi says that some big changes are on the way for 2020.

If you were already enrolled in an Advantage plan for 2019, you are now allowed to make changes if need be to your coverage. You have the option to cancel the plan entirely or switch to another plan, or even add an additional Part D plan that covers drugs. We will soon be adding a more detailed blog post on each of these options.

Regardless of whether you are making changes this year or not, you might want to take a minute to read about some of the new changes that are going to happen in 2020. Here’s an overview of the changes that you can see this year and in 2020.

An Overview of the New Benefits

For many years, the Advantage Plan had an unchanged, tiny list of supplemental benefits. They were comprehensive mind you. But left out some critical ones. The ones included were vision, hearing, and dental care. Thankfully, the Centers for Medicare and Medicaid Services (CMS) decided to relax that list at the end of 2018 making some great changes and add-on benefits. One of the most sought after ones is coverage for any goods and services as long as they reduce avoidable emergency department visits, or are used to diagnose, prevent, or treat injuries or health conditions.

The Advantage Plans have now expanded the very definition of the term ‘items eligible for coverage’. This now offers a gamut of new benefits, which are also dubbed wellness programs. Here’s what we know so far about these new benefits.

Nicotine replacement therapy – Advantage plan now covers Nicotine patches as well as other forms of treatment aimed at helping you kick the butt

Caregiver support services like respite care, counseling, and training – This is one of the most welcome additions to the list. Caregivers are often left to fend for themselves while providing chronic care that can last years. Now their needs are covered.

In-home support and personal care services like assistance with housekeeping tasks, bathing, eating, and dressing – If you or someone you care for is suffering from a chronic illness that demands constant attention, then you’d be glad to know that now Advantage plans cover in home paid support as well as personal care services.

Expanded coverage of over-the-counter products like non-prescription medications, compression stockings, and pill bottle openers – OTC products covered under the original Advantages plans was limited. The new coverage expands on the original list and includes the products that we have mentioned here.

Social worker phone line – If you would like to reach out to paid social worker services for counseling or financial aid related assistance, the new advantages plan covers it.

In-home palliative care – Palliative care for a chronically ill person is resource and finance exhaustive. Now it is covered by Medicare advantage, which means that all expenses that come under the umbrella term palliative care are taken care of.

Massage therapy – If your chronic condition requires massage therapy for healing, you’d be glad to know that you can engage the services of a licensed masseuse and claim it.

Transportation to places like the pharmacy or a fitness center – The addition of transportation takes a huge expense load off your shoulders. Be it to a pharmacy or a therapist, frequent visits can quickly add up the numbers.

Adult foster care – Many a time, the caregiver might require a breather. If paid at-home services are unavailable, they can now avail of adult foster care services which are also covered under the Advantages plan.

What can I expect in 2019?

The update about the newly added supplemental benefits came quite late. It was just a few months before insurers submitted their final plan designs. This left a lot of insurance companies with limited time to rearrange plans to include new benefits.

That said, CMS states that about 270 of the 600 plans for 2019 included at least one of the new benefits.

The most common additions to the list of added benefits were

  • Nicotine replacement therapy.
  • Caregiver support services.
  • In-home support.

No surprises there, really. These are some of the most demanding aspects of caregiving and personal healthcare. Most people who have used Medicare feel that the addition of these new supplemental benefits makes the service a more wholesome one that does not disregard some of the key aspects of long term healthcare.

However, end users would like to be aware of the fact that merely having a supplemental benefit offered by Medicare does not automatically make them available to everybody. Insurance companies have the right to offer only a selected few wellness programs or limit their availability to patients with certain health conditions only.

Don’t forget that now there might be even more differences in available benefits between different advantage plans. This may compound the already daunting task of comparison shopping and choosing the best coverage option.

To add to end users’ woes, the plan finder tool on Medicare’s website does not yet provide information about supplemental benefits offered by Advantage plans under this new rule. If you are looking for one or more of these supplemental advantages, you might have to check each Advantage plan directly. This is sad, the only way to know what supplemental benefits each plan covers and whether or not, there are any limitations or restrictions that could prevent access to these benefits.

More Changes on the way in 2020

In addition to broadening the scope of coverage and including the needs of caregivers, as well as taking social needs into consideration, there are some new benefits expected in 2020. The Bipartisan Budget Act of 2018 states clearly that Advantage plans shall offer supplemental benefits to those with chronic illnesses, even if they are not health related. These new additional benefit options should only “have a reasonable expectation of improving or maintaining the health or function of the beneficiary.” This greatly broadens the scope of what’s covered. In a nutshell, this means that as long as the expense is directly linked to improving or maintaining the health of a chronically ill person, it will be covered under new benefits.

Some additional services that may now be covered include –

Transportation for non-medical needs – Caregivers might have to travel frequently to get medications, for therapy, for groceries, or other supplemental care needs which are non-medical in nature. These will now be covered under the ambit of the new plan.

Home-delivered meals – A chronically ill person under the supervision of a caregiver may not be able to cook for themselves. The new plan now covers home-delivered meals as an expense that is linked to health or quality of life improvement.

Home modifications like installation of grab bars in the bathroom, wheelchair ramps, and air conditioners – Any senior care modifications made to the home, such as bump proofing corners, installing grab bars, or wheelchair ramps are now covered.

With the added flexibility to modify plans and include the new wellness benefits, CMS hopes that a much larger number of insurers will be able to reap these benefits beginning in 2020. As of now, it is not easy to find concrete information about these benefits though because they are not listed yet by the Medicare Plan Finder Tool. That said, it’s still early days and the landscape for plan enrollment in 2020 might change any time.

The New 2021 Update

A recent update reveals that 787 Medicare Advantage plans offered by 44 organizations now have access to some of the new special supplemental benefits for the chronically ill (SSBCI). While this is not an exhaustive list, here are some of the new supplemental benefits in addition to the ones that we have covered already.

  • Acupuncture – Acupuncture is used by almost 8.19 million Americans. The addition of this alternative therapy makes it a lot more accessible to chronically ill patients who might benefit from this.
  • Over-the-Counter (OTC) Items – There have been some additions made to the items covered under OTC. We do not have the exact list yet because it differs from one state to the other.
  • Health Education – Health education covers informative courses/webinars or counseling sessions that might make it easier to manage chronic illness. Both the primary recipient as well as the caregiver can avail of this service.
  • Nutritional/Dietary Benefit – If you would like to avail of nutritional services, such as working with a dietician, then you can get this as a supplemental benefit under some plans.
  • Additional Sessions of Smoking and Tobacco Cessation Counseling – While the earlier plan covered nicotine cessation, the definition has now been expanded to include any additional counselling sessions you may need to quit smoking permanently.
  • Fitness Benefit – The fitness benefits definition now includes a broader range of fitness related services such as fitness club memberships and even driving to one.
  • Tele monitoring Services – You can now get a supplemental benefit for availing a tele monitoring service for a chronically ill person.
  • Remote Access Technologies – This is pretty much like the earlier one. You can now remotely monitor your loved one if you have to step out of home or travel for work.
  • In-Home Safety Assessment – You can get your home evaluated for safe living for seniors. Also, any modifications that have to be made towards making the place senior-safe will also be covered. These include modifying the bathroom, installing smoke detectors, altering steps and walkaways to name a few.
  • Personal Emergency Response System (PERS) – A PERS, also called a Medical Emergency Response System can save your life during an SOS situation. However, these personal devices are expensive. The new supplemental benefits include this.
  • Wigs for Hair Loss Related to Chemotherapy – If a person you care for has lost their hair due to chemotherapy, you can claim the expenses for a new wig/hairpiece under the supplemental advantages.
  • Weight Management Programs – A lot of chronic conditions cause patients to gain weight uncontrollably. For instance, patients with Pulmonary Hypertension often gain up to 10-15 lbs. of water weight over a few days. You can claim both nutritional medical therapies as well as weight management programs as advantages.

Some big changes for 2022

The CMS in a new announcement has now made it mandatory for Part D plans to offer a real time cost benefit comparison tool. This rule will come into effect in 2022. The Part D prescription drug program will now offer information about lower cost alternative medications. This tool will enable enrollees to immediately compare the cost sharing benefits.

For instance, if their healthcare providers have prescribed a diabetes drug, the enrollee will be able to use this cost benefit comparison tool to know what the co-pay will be for this particular drug. They can also explore if there are similar drugs that are more cost effective. The idea behind the creation of this tool is to enable enrollees to know what it’s going to cost them before they make their way to the pharmacy.

By the way, we have curated a list of apps that might help you save money on medications for chronic illness. Do check it out.