Changes are coming to Medicare Advantage plans

Published Jun 24, 2018 at 9:00am

The Centers for Medicare and Medicaid Services (CMS) has recently announced a series of interrelated policy changes.

The goal of these changes is to give Medicare Advantage (MA) plans more flexibility to offer services that fall outside of traditional Medicare Part B coverage. Plans will now be allowed to provide a wider set of services that can be arranged to fit the specific needs of beneficiaries.  

These changes are the result of the passage of the Chronic (CHRONIC) Care Act of 2017. This bill makes a number of positive changes to Medicare. Currently, Medicare is designed to cover acute illnesses (short-term conditions) and not the long-term conditions that require home care or eventually institutional care.

The principle goal of Chronic is at least, in part, addressing this situation. A major component of this legislation includes the expanded use of telehealth, in particular using computers and video conferencing, to provide care for people living at home with difficult to manage chronic conditions. Patients will able to use telehealth as long these methods are used as supplements to periodic face-to-face provider visits.

The CHRONIC Act also makes important changes in a number of other areas. These include such things as improved identification of chronically ill beneficiaries and additional support of caregivers. While the current law restricts the enrollment of certain classes of special-needs individuals, starting next year MA plans will be able to expand the enrollment opportunities to more people who fall into these high risk/high need categories.

Changes to Medicare Advantage Plans. Recently CMS made a series of interrelated policy changes, as mandated by the CHRONIC ACT, to give MA plans more flexibility to offer additional services outside of traditional Medicare.

Known as supplemental benefits, in the past these services have included such things as dental, vision, and hearing benefits. But, by allowing plans to offer an even wider and expanded array of services, CMS expects that MA plans will be in a better position to both attract new members and to better meet more beneficiary needs.

CMS has notified plans that for 2019 it will expand the scope of permitted services to include such things as non-skilled in-home workers, portable wheelchair ramps and other assistive devices. In addition, MA plans will now have the ability to target supplemental benefits to fit the needs of specific groups of enrollees. In the past, benefits could only be offered to all participants in the plan.

As an example, under these new rules plans may now decide to offer specific benefits only to enrollees with diabetes. Such a benefit might be payment for more frequent foot exams for diabetes patients. More frequent visits have been shown to both save money and produce better outcomes for both the plans and the beneficiaries. 

Finally, beginning in 2020, CMS will create a third category of “chronic” supplemental benefits. This new category will allow the plans to focus services like non-emergency transportation for individual chronically ill beneficiaries.

In sum, over the next two years CMS will widen the scope of generally available supplemental benefits, permit benefits targeted at certain enrollee populations while allowing plans to offer a broader range of services to individual chronically ill members under certain circumstances.

Impact of more plan flexibility on Medicare. In addition to these newfound flexibilities, MA plans are also set to receive a substantial revenue increase next year. The combination of higher rates and less restrictions on extra benefits should lead to greater oversight by CMS of all the plans. Increased oversight will be needed to ensure that the high-cost enrollees actually receive these new benefits. CMS must ensure that these new benefits are actually being delivered and high need patients are not being excluded in favor of less costly, healthier patients. It will also be important to see what happens when patients begin to rely on these new services and the plans encounter a “less favorable” rate environment. If this happens, will they request to discontinue the new services?

It is important to note that the CHRONIC Act was passed unanimously by the Senate. For example, Sen. Ron Wyden, D-Oregon, lauded the passage of the CHRONIC Act stating that it has begun the transition of Medicare from an “acute care” to a “chronic care” program. Oran Hatch, R-Utah, a co-sponsor of the legislation along with Senator Wyden, stated that the “Chronic Care Act is a culmination of a bipartisan, committee-wide effort.” It was included by the House in the recent budget deal and was signed by the president. 

What will all these changes mean for Medicare beneficiaries? The changes that will come about as a result of the passage of the CHRONIC Act will have positive benefits for all Medicare beneficiaries.

First, the changes are expected to allow the plans to hold down premium increases for all their members. Second, they will expand the number of services they can offer to their members with severe chronic conditions. It will provide much greater and affordable coverage choices, especially to those with severe chronic conditions who may have been priced out of the MA plan market. 

Who do I contact in Oneida County for help with my Medicare Advantage plan? The Oneida County Office for the Aging/Continuing Care/NY Connects Health Insurance Information, Counseling and Assistance program (HIICAP) offices provide their services at no cost to Medicare beneficiaries. HIICAP offices are found at the Ava Dorfman Senior Citizens Civic Center, 305 E. Locust St., with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m. Consumers are seen on a “first come, first served” basis, so call the Dorfman Center at 315-337-1648 to see if there are long wait times.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm which located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.