New Benefits Likely for Medicare Plan Enrollees


Imagine getting your Medicare health plan to foot the bill for your home’s grab bars or wheelchair ramps. 

That could be the case next year for some beneficiaries who enroll in Medicare managed care plans that offer these benefits.

The Medicare agency last week asked the public whether it should allow Medicare Advantage plans to offer items and services as supplemental benefits beyond those that are strictly medically necessary. The primary purpose of the item or service would nonetheless have to be to prevent or treat an illness or injury, compensate for physical impairments, or reduce avoidable use of emergency services.

But that’s a departure from Medicare’s long-standing policy of denying coverage for things like stair-lifts or flashing doorbell signals.

Medicare Advantage plans submit “bids” based on how much they think it will cost them to pay for services for their enrollees. These are compared to benchmark amounts that vary by county. If the bid is lower than the benchmark, the plan gets to keep part of the extra money to use for supplemental benefits to attract enrollees.

Medicare last week put the idea for additional supplemental benefits in proposed guidance for 2019.

The proposed expanded definition is a “big win” for beneficiaries who enroll in Medicare Advantage, Seema Verma, head of the Centers for Medicare & Medicaid Services, said.

But it could also be a plus for companies.

It opens up the door for entities that provide such services as home health and nutritional supplementation to partner with plans, Sean Creighton, a consultant at Avalere Health, told me.

Creighton should know. He spent 15 years working on policy development at the Medicare agency.

More details on supplemental benefits are to come.

The agency said it will issue detailed guidance for Medicare Advantage plans before they have to submit bids in June.

Read my full story here.

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