Medicare Advantage Plans are providing more help for fragile and weak Seniors. Over 30 million Medicare patients are enrolled in Medicare Advantage, and other Medicare managed care programs (MA). And these programs are increasingly providing modest but essential non-medical services to the elderly living at home.
These additional services are the only Medicare benefits for long-term care that most seniors will get. The support may include a meal and prepared food delivery, transportation, personal care, and home adaptations.
Minimal Long-Term Care
Medicare Advantage benefits should not be confused with long-term care insurance. According to a new assessment from the Government Accountability Office, their average monthly worth is far less than $50 and may be as low as $10. MA assistance might be fully integrated with the medical treatment provided by the plan. This might be a significant advantage, particularly if the advantages are increased.
Plans are more eager to provide these additional advantages. In 2020, their first year of availability, around 600 plans were offered to seniors. According to research by ATI Consulting, more than 2,200 out of 4,000 plans are doing so in 2023.
Plans in the past could only offer limited services, such as vision care and hearing aids. However, the CHRONIC Act of 2018 permitted insurers to increase these new benefits. The Special Supplementary Benefits for the Chronically Ill include meal delivery and transportation. New, mainly health-related, additional benefits may include adult day programs, assistance for caregivers, and home-based palliative care.
Though they rarely do, plans may charge additional charges for certain services. Instead, they employ government bonuses meant to reflect quality and cost savings. According to the Commonwealth Fund, however, these rebates are contentious and averaged $164 per member per month in 2022. Most of this funding is allocated to benefits, such as gym memberships and vision care.
Only three insurers covered 60 percent of all MA participants in 2022: United Healthcare, Humana, and Blue Cross Blue Shield. Yet, smaller MA plans are more likely to provide many of these additional benefits.
While over 900 plans provide meal delivery this year, roughly 13 percent of participants are enrolled in these programs. As most MA subscribers are ineligible due to good health, the number of members getting these benefits is significantly fewer.
Why do plans provide these additional benefits? Marketing tactics such as hearing aids and gym memberships are successful. Over 90 percent of plans provide them as a result of consumer demand, according to the Kaiser Family Foundation. Insurers cannot be left behind, as customers can access various MA plans.
Supporting services are diverse. On the one hand, insurers may be hesitant to give them because they may be most appealing to individuals who currently require this support, hence increasing plan costs.
Yet, this risk might be mitigated by a substantial cash reward. The federal government provides monthly fixed amounts to health plans to cover all essential treatment for its members (the average base amount is $1,000). But, a plan will quickly exhaust this money if a member requires hospitalization.
It can retain more of the government’s money if it can reduce its medical expenses by providing services and assistance. Some experts estimate that as many as fifty percent of hospitalized elderly persons are malnourished upon admission. Imagine the savings if plans could limit these admissions by supplying their members with reasonably inexpensive food or prepared meals.
Most MA plans have declined to divulge cost or quality information on these benefits. And, astonishingly, Congress has never intended to make data accessible to federal regulators. Yet, we may be able to learn something by observing how these advantages are provided.
There are now 929 plans offering food delivery, up ninefold since 2020. In-home support services, like personal care assistants, are the most prevalent benefit, with 1,091 plans offering them this year, a fourfold increase from 2020. This indicates that these features are desirable to subscribers and cost-effective for the plans. It may even increase patient well-being. However, this cannot be confirmed.
Simultaneously, the number of plans that offer adult day services decreased from 84 to 41, and the number of plans that offer therapeutic massage decreased from 221 to 187. This might indicate that members lacked interest in these offerings, and conversely, it might indicate that the return on investment was low or even negative.
Ron Wyden (D-Oregon), the Senate Finance Committee chairman, is examining ways to boost CHRONIC benefits in Congress. Some Democrats desire to extend these benefits to Medicare beneficiaries. These additional benefits are currently a real-world trial. Wyden believes we could learn much about these supports and services’ health-related and financial advantages if we had greater access to plan data.
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