Thanks to recent public policy changes, consumers shopping for a Medicare plan just might want to give Medicare Advantage another look, as it now offers more supplemental benefits, according to the AARP.
Medicare’s private plans, including Medicare Advantage (MA), have long been allowed to offer additional extra benefits that Medicare does not, such as vision, dental care and gym memberships. But new federal regulations tied to the Bipartisan Budget Act of 2018 have allowed an even wider array of benefits this year and give insurance carriers greater flexibility in providing them, according to a report by the AARP Public Policy Institute.
In 2018, over 20 million beneficiaries—about one-third of all Medicare beneficiaries—were enrolled in MA plans, but with regulatory changes to policies governing MA supplemental benefits taking effect for plans sold in 2019, even more people are projected to enroll in them in the coming years, the report said.
When fully implemented in 2020, the new rules will allow more MA plan benefits to qualify as “primarily health-related" and cover special benefits for people with chronic diseases, the report said.
The Centers for Medicare & Medicaid Services (CMS), which adminsters the Medicare program, previously only allowed supplemental benefits whose primary purpose was to “prevent, cure or diminish an illness or injury.”
Under the new regulations, CMS broadened the definition of a “primarily health-related” benefits to include those that “diagnose, prevent, or treat an illness or injury; compensate for physical impairments; act to ameliorate the function/psychological impact of injuries or health conditions; or reduce avoidable emergency and healthcare utilization,” according to the report.
CMS also lifted a ban on services for daily maintenance, such as maid services, smoke detectors, or massages, and on supplemental benefits covering long-term services and supports, such as in-home assistance, services to family caregivers, and portable wheelchair ramps.
Starting in 2020, MA plans will be allowed to offer enrollees diagnosed with a chronic illness supplemental benefits that are not health-related, such as ride-hailing non-medical transportation, home-delivered hot meals, air conditioners, in-home help with bathing and dressing, minor home repairs, or supervised housing, the report said.
In the past, MA insurers were required to cover the same supplemental benefits for all enrollees in a service area and to charge the same premium and cost sharing to all enrollees—a requirement known as the “uniformity rule.” CMS regulations for 2019 and beyond relax this requirement to allow insurers to offer targeted benefits, according to the report.
For example, the report said, an MA plan could decide to cover more frequent foot exams, reduce cost-sharing for endocrinologist visits or offer a lower deductible only for enrollees with diabetes. However, CMS continues to require that MA insurers charge the same premium to all enrollees in the plan.