Question: I read an article that Medicare Advantage Plans will start covering care provided in my home. Which plans cover that type of care? How much help will it pay for?

Answer: I had an opportunity to read an article like that myself. I first want to clarify that Medicare has changed the rules for Medicare Advantage Plans, with regard to covering Home Care Services. Beginning in 2019, Medicare Advantage Plans are allowed to cover a range of In-home services. This is a brand new benefit, above and beyond what Medicare and the Medicare Advantage Plans have covered in the past.

Medicare Advantage plans have covered additional services not covered by Medicare for many years. Some examples we are familiar with are Health Club Memberships, or hearing aides, or money to help pay for eyeglasses. These are all items that Original Medicare does not cover, but the Medicare Advantage Plans can, and some do.

Medicare and Medicare Advantage Plans have covered limited services within the home for as long as I can remember. That coverage had been limited to a few specific situations, such as services at home after a hospital stay with continued therapies, wound care, or nursing services for a short period of time. Another situation could be a significant change of condition without a hospital stay. This could be something like a fracture which did not require a hospital stay, but prevents you from being as independent as you were prior to the injury. Another situation could be Hospice Services, if an individual qualifies for Hospice care, some limited home care comes with that benefit.

Medicare & Medicare Advantage Plans usually covers Home Care from a Certified Agency for a short period of time. That “short period of time” could be two or three home care visits or a number of weeks, depending on your recovery. The Certified Referral is usually done from the doctor’s office or the hospital stay. This is a called a Certified Referral, because in order for Medicare to cover the services, it must be from a Certified Home Care Agency. This is a special licensure or accreditation issued from the Department of Health. This certification means they can bill Medicare + related insurance companies for the services they provide.

Currently, Home Care services are only provided if the individual requires Skilled Nursing Services (like wound care or medication management/education) or a Therapy Benefit (Physical, Occupational or Speech). In all the situations previously listed, the benefit has been usually short term 2 weeks to 2 months, and usually occasional services (once or twice a week). So this type of Home Care coverage is not usually adequate to maintain someone living at home with special needs for an extended period of time.

The changes for 2019 allow Medicare Advantage Plans to offer additional services, not traditionally covered by Medicare. These include services like adult day care, housekeeping, non-medical transportation, etc for the individual. Also, services including help for family caregivers with counseling, education/training and respite services could be offered by the Medicare Advantage Plans.

These are all new benefits the Medicare Advantage Plans are allowed to offer. In practice, what we have found is that the law changed too late for many of the Medicare Advantage Plans to include these new possibilities in their list of benefits for 2019. We may find more plans offering some of these additional benefits as part of their package in the years ahead.

As I wrote in a recent article about Medicare Advantage Plans, over 40 percent of seniors in our region have Medicare Advantage Plans. There are 29 different Medicare Advantage plans available in Chautauqua County (31 in Cattaraugus County). NONE of the Medicare Advantage plans in our region added these available benefits for 2019. I do believe that we will see them add some of the benefits in future years.

These additional services, adult day care, housekeeping, non-medical transportation, etc. will be another variable to consider when evaluating your plan options. These are services that could keep you living independently in your current situation. This comparison in future years may find that additional services are more important to you than having lower medication co-pays or lower hospital co-pays. Your Medicare Advantage Plan in the future may offer some of these benefits and that may make the premium higher.

The Medicare Advantage Plans are private companies offering you insurance and they need to be sure that their plans are affordable for their bottom line as well. Additional types of in-home help may prevent illness or injuries that would cost more money in the long run, for you and the insurer. Each Medicare Advantage Plan will have the opportunity to evaluate the list of benefits they are allowed to offer and decide if they in fact want to include any of these benefits in their plans. As we move forward we may find more and more plans offering this type of benefit. That added benefit might increase the costs you pay. We really won’t know more until we begin seeing what plans offer in 2020.

Now you see why I get so excited about Oct. 1 each year. That is when we find out what the plans are offering in the coming year. This could be pretty exciting for you too!

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.