Always more to learn in the world of home health care and aging in place these days. Some folks are aware that last fall a limited number of Medicare Advantage Plans began to offer the option to sign on for extra benefits. To start with these were very basic – a add on to your supplement plan for eyeglasses and hearing aides. Looking forward to sign up periods for 2020 and 2021, there will be a lot more in column B.
Starting next year MA plans will be allowed to provide a wide range of additional services including adult day care, transportation, respite care for caregivers, in-home aides, and safety devices such as grab bars, stair rails, and temporary ramps and even pest control. Sounds terrific doesn’t it?
So the MA landscape is going to expand into paying for home modifications and other services BUT ONLY for those with chronic conditions. Read that again for those with chronic conditions. That does not mean just being old. Anyone with a brain in their head would think that adding grab bars in the bathroom, non glare lighting for older eyes and wider doors (and about a dozen other changes for safety) would be best done before some one becomes chronically ill. However, the word proactive never sits well with insurance companies.
Already they are arguing about how if a person got an Advantage plus plan and added basically permanent improvements to their home, there is nothing to stop them from changing plans (as we can every year ) before the first insurer could benefit from no falls etc in subsequent years.
I have been trying to gather some cost predictions for these new kind of plans. We will have to wait until the fall to see how much do you pay in extra insurance premiums to get a preset amount maximum for improvements and services. How significantly disabled do you have to be before they give them to you. From the policy wonks of CMS:
Section 1852(a)(3)(D)(ii), as amended, defines a chronically ill enrollee as an individual who:
1) has one or more comorbid and medically complex chronic conditions that is life
threatening or significantly limits the overall health or function of the enrollee;
2) has a high risk of hospitalization or other adverse health outcomes; and
3) requires intensive care coordination.
Again an opportunity to get way down in the weeds of Medicare policy:
The next wave of new benefits then may wash over many of us. As it stands only one third of Medicare folks have the MA plans and these new benefits do not apply to regular Medicare. So read the large print – the small print and do not jump into the water too fast without considering what you really have to gain.