There are a number of improvements to Medicare for the next couple years, but perhaps the one that got the most press are the coming changes to Medicare Advantage plans.
Part C Medicare Advantage plans have been gaining steam for a number of years, and currently, about one-third of all Medicare beneficiaries are enrolled in one of these plans.
Having worked with these plans since 2005, we’ve had a unique opportunity at Boomer Benefits to witness the growth of these plans. Beneficiaries who enjoy these plans list a number of reasons including:
- Lower premiums than Medigap – as low as $0 on some plans
- Out-of-Pocket limit on your healthcare spending
- Part D drug benefit rolled in (on most plans)
- Access to ancillary benefit extras like routine dental and vision
- Some plans even have gym memberships
Sometimes people opt for Medigap plans because they don’t like the idea of having to use a network with Medicare Advantage plans. However, now that plans will be able to increase their supplemental benefits, we may see that some beneficiaries are swayed into giving Advantage plans a try.
New Medicare Advantage Supplemental Benefits
Thanks to the Chronic Care Act, we can expect to see Advantage plans beginning to offer more benefits than ever before in 2020. The definition of supplemental benefits has been broadened to include social and medical services, adult day care, home modifications such as bathroom grab bars or wheelchair ramps, trips to doctor’s offices and pharmacies and delivery of hot meals to beneficiaries’ homes.
These benefits will help to prevent things like falls that can be very costly to treat. A new focus on prevention aims to lower Medicare spending on things like injuries from slips and falls, which can be costly to treat.
The Act also provides financial incentives for using telemedicine services. This may make it easier for beneficiaries who live in rural areas to consult specialists via a video conference. It is also expected to reduce emergency room visits and prevent hospitalizations.
Reasons for the Changes
The changes were made to advance the level of care that is delivered to individuals with complex needs. About half of Medicare patients are treated for multiple chronic conditions each year.
The law seeks to improve the way that Medicare functions for beneficiaries with chronic illnesses like diabetes, dementia, heart failure, and rheumatoid arthritis
The law also protects and builds upon certain programs that serve beneficiaries with both high needs and high risk, such as dual eligible (beneficiaries with both Medicare and Medicaid) and people living in institutions.
Medicare Advantage plans will be able to tailor their offering. For example, they might offer adult day care options only if the member is diagnosed with specific health conditions like memory loss or dementia.
Keep in mind that with both Medicare and Medicare Advantage plans, services are provided when they have been deemed medically necessary by your physician. The law states that supplemental benefits must “have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee.”
Key Facts about Medicare Advantage Plans
It’s important to remember that Medicare Advantage plans can and do change their premiums, benefits, copays, coinsurance, provider network, pharmacy network and drug formularies every year. It’s possible that a plan may offer one of these supplemental benefits one year, and then discontinue those benefits the next year.
For this reason, we continually tell beneficiaries at our agency that if they choose to enroll in a Medicare Advantage plan, they need to choose their plan based on how well it covers their medical conditions, not on whether it includes a free eye exam. Medicare Advantage members should also be prepared to do their homework each September. They should carefully review the annual notice of change letter sent to them by their plan each fall so they are aware of which benefits will be different next year.