On The Money Medicare Advantage

The federal government is giving insurers who offer Medicare Advantage plans more leeway to pay for things they’d ordinarily never cover, with the idea of improving health and preventing costly medical problems.

Medicare Advantage customers will soon be able to choose from new insurance benefits that go well beyond the usual coverage of doctor visits and other care in an effort to improve their health and prevent costly medical problems.

Pest control, food for a service dog, pharmacy staples such as aspirin and toothpaste, in-home personal care to help with dressing and bathing, acupuncture and therapeutic massage treatments, sessions with nutritionists and assistive devices such as shower stools are among the new supplemental health benefits that privately run versions of the government’s Medicare program could be offering starting in 2020. Enrollment for plans runs from Oct. 15 to Dec. 7.

Jane Sung, a senior strategic policy adviser with the AARP Public Policy Institute, said the new services are all part of an effort to address the health of Medicare Advantage enrollees from a more complete perspective.

“If you address issues that affect health, such as meals and support for care givers, it goes a long way toward improving overall health,” she said. “That can save the program more money.”

Medicare Advantage plans already offer extras such as dental benefits, vision coverage or gym memberships that regular Medicare doesn’t provide. But Medicare Advantage can restrict access to a network of doctors or hospitals. Medicare doesn't have those restrictions. 

About a third of the people on Medicare opt for Medicare Advantage plans, according to the nonprofit Kaiser Family Foundation. In mid-2017, there were nearly 170,000 Medicare Advantage customers in Louisiana, according to a Kaiser report.

The federal government is giving Medicare Advantage plans more leeway to pay for things they’d ordinarily never cover. The new supplemental benefits aim to help people with chronic diseases or certain health issues stay healthy when they aren’t seeing a doctor or receiving care.

“Medicare has made a concerted effort to innovate more health and wellness programs,” said Mitch Lubitz, a spokesman for Humana, the largest Medicare Advantage provider in Louisiana.

But the items may not be available to all Medicare Advantage enrollees. The pest control, for example, might be available only to customers with chronic conditions that are made worse by bedbugs. Meetings with nutritionists to help develop a healthy diet are only covered if the person has a qualified condition, such as diabetes. In-home personal care is available for people with conditions that limit their daily living activities. 

These new benefits will only be available through Medicare Advantage plans, not regular Medicare, and insurers are not required to offer them. Whether they do can depend on what they think their customers need to stay healthy.

Aside from these supplemental offerings, many plans also will provide telemedicine benefits to help patients connect remotely with doctors and other care providers.

Nick Karl, vice president of sales for UnitedHealthcare, which also owns Peoples Health and is the second-largest Medicare Advantage provider in Louisiana, said some plans even reimburse people for part of their Medicare Part B premiums, freeing up some of their money. “Socioeconomic status matters,” he said. “People are not having to make a decision between paying for their drugs and putting a meal on the table. That’s going to cause better health outcomes.”

Martin Esquivel helped Healthy Blue — a collaboration between Blue Cross Blue and Shield of Louisiana and Anthem — develop its Medicare Advantage plans. He said some expanded services have been offered since the start of 2019, such as home helpers. It's too early to see what sort of impact those services have had so far, but Esquivel said the utilization fits in with the early projections.

“The Centers for Medicare and Medicaid Studies created the flexibility guidance so we could offer more unique and tailored types of benefits,” he said. “Medicare is designed to be reactive. You have a health issue, a claim gets submitted, it gets paid …. This is shaping the program differently to save money and create a better experience.”

Consumers need to do their homework when they are looking at the wide range of new benefits, said Vicki Dufrene, senior health director for the Louisiana Department of Insurance. For example, the Healthy Blue Essential Extras package allows customers to choose from one of 10 supplemental services, including 64 healthy meal deliveries a year, 60 trips to health-related appointments, a fitness tracker or weekly trips to adult day center services.

“Some of these extras are not offered to every single individual, so you need to do research and make sure you meet the qualifications,” she said.

And while some of the new services are useful and can help a patient feel better, they need to be weighed against the other factors that go into choosing a Medicare Advantage plan, such as prescription coverage and if your doctor is included in the network, Dufrene said.

Seniors with any questions about Medicare Advantage plans can call the Department of Insurance at (800) 259-5300, check with their local Council on Aging or regional groups such as the Capital Area Agency on Aging, the Jefferson Council on Aging, the New Orleans Council on Aging or the Cajun Area Agency on Aging.

Insurers started marketing their Medicare Advantage plans last week. Customers still have about a week to learn about any coverage changes or added benefits before the Oct. 15 start of the annual open enrollment period. Shoppers will have until Dec. 7 to enroll, switch to another Medicare Advantage plan or opt for regular Medicare and add prescription drug coverage for 2020.

After that, Medicare Advantage customers who regret their decision can make one change in the first three months of 2020. That second window applies only to those who already have a Medicare Advantage plan.

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The Associated Press contributed to this report.

Email Timothy Boone at tboone@theadvocate.com.