With the all the changes in the House of Representative coming in January 2019, we can hold our breath for any last minute attempts for Congress to dismantle Medicare and Social Security.  I was heartened to read that just the opposite may be happening.  But with my usual brand of cynicism lets us look at what may happen to our Medicare Advantage plans in the next few years.

Not everyone has Medicare Advantage (about 1 in 3 seniors). You pay privately at market rates for Plan C , after you pay a set rate for the government’s Plan B.  These advantage plans vary in cost and pick up the 20% of medical costs that Medicare does not pay.  There was a Chronic Care Act brought out a few months ago that talked about expanding services to telemedicine and home modifications for the chronically ill.  That was not really something new (except for the telemedicine part).  Durable medical equipment has been already been provided in more extreme cases to buy wheelchairs and even ramps.

Now it is being touted that CMS will increase its payouts in 2019 by 3.4%.  It is the only direction Medicare can go as the age wave hits the lack of affordable care and senior housing in general. The motivation is to bring down the cost of long term care by keeping people in their homes. It should be a win-win proposition. Medicare must safeguard its solvency.

But as anything with government ‘entitlements’ there must be a line of proven need – not choice.  The current regulations are for those who are at the end of being able to do even the most basic of  Activities of Daily Living (ADLs), dressing and feeding themselves. In other words you have to be one step away from the nursing home door to have anything covered.

Seeing a headline like this – Next Avenue * makes me question how much of a private public partnership this is really going to be.

The Centers for Medicare and Medicaid Services (CMS) recently announced that it will be expanding the definition of “health-related” supplemental benefits in Medicare Advantage plans to include “additional services that increase health and improve quality of life.” These would include benefits that “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”…For the first time, Medicare Advantage plans will be able to offer services such as home modifications, home-delivered and medically-tailored meals (currently limited to a very small number of conditions) or aides to help with activities of daily living.

There is always a bar to jump over, to prove you are in dire need of said service. This change may benefit the private insurance market first and some consumers later. I am hoping I am wrong.  Home modifications like grab bars, ramps and home visits and home delivered meals should be brought on as individually needed.  I would hope that criteria for receiving services would not be wholly managed by the private insurance market.  Or we may be right back to fighting off privatization of the whole system.

Stay tuned for more gargoyle watch.