Medicare’s big push to boost in-home aid

Medicare’s big push to boost in-home aid

by Advisor Websites_2 on Jan 20, 2019

SF Chronicle Section D November 10, 2018 Page D1 – 2

After an Election Day largely free of viral social media misinformation, and with little trace of the kind of Russian troll stampede that hit its platform in 2016, executives at Facebook may be tempted to take a victory lap.

That would be a mistake.

It’s true that Facebook and other social media companies have made strides toward cleaning up their services in the past two years. The relative calm we saw on social media Tuesday is evidence that, at least for one day, in one country, the forces of chaos on these services can be contained. But more than anything, this year’s midterm election cycle has exposed just how fragile Facebook remains. Change is starting slowly. Policymakers have yet to figure out how to bring similar benefits to traditional Medicare, still the choice of 2 out of 3 seniors.

The new services will be offered by some Medicare Advantage plans in more than 20 states next year, and that’s expected to grow over time. There has to be a health-related reason to qualify, and costs will vary among plans. In some plans, there’s no added cost. But limits do apply. For example, a plan may cover one day per week at an adult day care center.

Nearly 23 million Medicare beneficiaries, or more than 1 in 3, are expected to be covered by a Medicare Advantage plan next year. The private plans generally offer lower out-of-pocket costs in exchange for limits on choice of doctors and hospitals and other restriction such as prior authorization for services. It’s a growing business for insurers.  Medicare Advantage open enrollment for 2019 ends Dec, 7. But it's not easy to use Medicare's online plan finder to search for plans with expanded benefits, so beneficiaries and their families will have to rely on promotional materials that insurers mail during open enrollment.

Insurers under Anthem's corporate umbrella are offering different packages in 12 of 21 states where they operate Medicare plans. They can include alternative medicine, like acupuncture, or adult day care center visits or a personal helper at home. Other major insurers like UnitedHealthcare and Humana are participating. It's a calculated gamble for insurers, who still have to make a profit.  And the limited new benefits are no substitute for full long-term care coverage, which many people need for at least part of their lives and remains prohibitively expensive. Seniors trying to get long-term care through Medicaid, the program for low-income people, must spend down their life savings.

The changes represent a rare consensus at a time when health care issues are among the most politically divisive. Republican and Democratic lawmakers, as well as Seema Verma, the Trump administration's Medicare chief, are pulling in the same direction. The idea of broader services through Medicare Advantage was embodied in a bipartisan Senate Finance Committee bill to improve care for chronically ill seniors. The Trump administration issued regulations in the spring trying to accelerate the changes.  According to Medicare, 12 insurers will be offering expanded supplemental benefits next year through 160 plans in 20 states. In four other states and Puerto Rico, such benefits may be available to seniors with certain health conditions. "The guidance came out fairly late in the annual planning process, and that's one reason why some of these benefits may start out small," said Steve Warner, head of Medicare Advantage program development for UnitedHealthcare.

Medicare estimates that some 780,000 beneficiaries will have access to the new benefits next year. In-home helpers and support for caregivers are the most popular. Consumer advocates recommend that seniors carefully weigh whether Medicare Advantage is best for them. If they don't like it, they can go back to traditional Medicare, but those with a pre-existing condition may not be able to buy a Medigap policy to help cover out-of-pocket costs. They can also switch to another Medicare Advantage plan. Medicare doesn't pay the insurers more for offering added benefits. Under a complex formula, they're primarily financed out of the difference between bids submitted by insurers and Medicare's maximum payment to plans. If the companies bid below Medicare's rate, they can return some of that to beneficiaries in the form of added benefits.