Are You Getting The Most From Medicare?
With rising healthcare costs stress families across the country, turning 65 may feel a bit like entering the promised land—only milk and honey is represented by the availability of Medicare.
There’s no doubt that this federal health insurance is a blessing, given the alternatives of unsubsidized private insurance. But are you or your loved one taking full advantage of it?
Medicare can bewilder people, especially those new to the jargon. There’s Medicare Parts A, B, C, and D—not to be confused with Medigap Plans A through N. Of course, Medigap E, H, I, and J have been unavailable to new subscribers for a while now. And Medigap C and F ceased to be available to new subscribers on January 1, 2020.* On top of all that, you can’t opt for any Medigap plan if you have Medicare Part C, which also goes by the name Medicare Advantage.
Is your head spinning yet? You aren’t alone.
While there are entire websites devoted to helping people understand Medicare, this post focuses on Medicare Advantage (MA). Medicare Advantage is the supplemental coverage available to any Medicare-eligible person who is enrolled in Medicare Parts A and B.
As you may or may not know, private insurers who have contracts with the federal government administer MA plans. They generally offer a wider array of benefits to enrollees than traditional Medicare. These benefits may include drug coverage, even if you aren’t enrolled in Medicare Part D. A few changes have happened to these plans over the last couple of years that you should know about.
MA plans guidance and rules are established by CMS, the Center for Medicare and Medicaid Services. In 2018, they took the bold step of expanding the benefits an MA insurer can provide to include certain home care benefits.
CMS has always insisted that benefits be primarily health related. In 2018, their interpretation of what “primarily health related” means grew to include additional tasks. For instance, assistance with bathing, dressing, and other activities likely to diminish the risk of illness, injury, or rehospitalization might be covered.
Many expected MA plans to jump at the opportunity to include these benefits in their plans. After all, consumers like options and MA plans are offered by private companies competing for the business of consumers. But a proliferation of such benefits didn’t really happen. In 2019 (the first year these rules were in effect), only about three percent of MA plans offered them.
Then, CMS announced new guidelines in 2019 that further expanded the benefits MA plans could offer. This time around, CMS signalled approval of any benefits that “have a reasonable expectation of improving or maintaining the health or overall function.” This ruling clearly addressed the need of those with chronic illnesses, which is a vast number of aging Americans. With this pronouncement, transportation to physician’s appointments, housekeeping, personal care services, and could now be included in your MA plan.
Currently, MA plans are exercising caution with regard to how many newly permitted benefits they offer. The thinking is, simply put, that they don’t want to expose themselves financially. Only about 12% of MA plans offer these services in 2020, but you can expect that number to grow in the coming years.
What to think about moving forward
Where does this leave you? Should you stick with traditional fee-for-service Medicare? Should you seek out an MA plan that offers such expanded benefits?
Since, you can enroll in MA and change Medicare plans every fall, here are some questions to think about before the next enrollment period comes around:
Do you or a loved one have a chronic health condition?
Do you or a loved one feel less confident driving yourself around?
Is transportation a challenge for you or your loved one?
Does preparing a well-balanced meal that meets your physician’s nutritional recommendations feel like too much of a chore?
Do you or a loved one make excuses about bathing at least twice a week?
If you can answer yes to any of these questions, consider exploring MA plan options that include the expanded benefits an aging in place company like Ovation Home Care offers. Non-medical home care services are known to improve the overall health and wellbeing of those aging in place. How? By providing improved safety and hygiene, and guarding against social isolation.
Shop around, by all means, and find a plan whose premiums are reasonable given the benefits you may need to use.
Of course, if you have specific questions about your situation, feel free to reach out to us at [email protected]. One of our care advisors would be honored to help you understand all the ways we can assist and support your goal of aging in place.
*The benefits were just too good and people were visiting their doctors at the drop of a hat; just because Medicare isn’t a private program doesn’t mean the government isn’t concerned with costs.)
**Much respect to anyone who thought of David Bowie when reading this subhead.