What You Need to Know About the Upcoming Changes in Medicare Advantage

25 September 2018 |

What You Need to Know About the Upcoming Changes in Medicare Advantage

In the middle of October, Medicare will begin its annual open enrollment period for coverage in 2019. If you were thinking about simply renewing your same coverage, you might want to reconsider.

Congress reviewed and passed a new spending bill this year that will provide extra coverage to help prevent medical problems instead of only repairing them. This means some exciting new changes for Medicare Advantage holders. When enrollment opens this fall, here’s what you need to know.

Medicare

Coverage of Non-Medical Related Items

One of the biggest updates, due to the spending bill, is coverage of non-medical care items. For example, falls in the bathroom are among the most common injuries for the elderly. Wet surfaces increase the likelihood of slippage and hard surfaces increase the likelihood of serious breaks.

In the past, Medicare Advantage plans would have shelled out thousands to cover the costs of surgery, physical therapy, recovery, and medications, but they wouldn’t cover the cost of grab bars next to the toilet and shower that would have prevented the injury in the first place. Many elderly patrons on Medicare plans can’t afford the few hundred dollars it would take to install the bars, so they simply live with the hazards.

Congress decided it would be a much better use of their money to cover these non-medical-related expenses in the name of preventing injury rather than just allocating all spending towards medical treatment. Now, non-medical related expenses like grocery delivery, transportation for medical care, home health aides, and home-safety equipment will be covered starting with your 2019 plans, much to the pleasure of those in geriatric medicine.

“What I find most fundamental is the recognition, by C.M.S. and Congress, that this bright line between ‘medically necessary’ and things necessary to maintain health — like proper nutrition and transportation to a doctor’s office — is an illusion,” Dr. Diane Meier, a geriatrician at the Center to Advance Palliative Care in New York, said in an interview with the New York Times. “Failure to invest in simple things like safe housing and transportation means you will invest in hospitalization and emergency room visits.”

Since the announcement was made earlier this year, there’s not a lot of time for them to make substantial changes to 2019 plans. Therefore, it’s expected that we’ll see even more changes in this regard for 2020 and beyond.

We’ll See an Increase of Long-Term Care Plans

Another key improvement to the Medicare Advantage plan is extended coverage for long-term care plans. Long-term custodial care was left out of normal coverage in Medicare Advantage plans, but no more. The goal is a more managed-care approach to ensure that patients are being treated with what works.

“This will potentially help people stay in their homes longer and not have to go to institutions,” Seema Verma, the C.M.S. administrator, said in the same interview with the New York Times. “You could provide a simple device or a home modification that could mean the world to a patient, but plans weren’t allowed to do that in the past.”

Enrollment Changes

During the enrollment period for 2019, you’ll have a few options to change your plans and take advantage of the spending bill changes. The enrollment and disenrollment period have been extended, and you can switch to a different Medicare Advantage plan if you wish.

According to the Medicare website, you’ll also have the option to:

  • Drop your Medicare Advantage plan and return to Original Medicare.
  • Sign up for stand-alone Medicare Part D Prescription Drug Plan when switching to Original Medicare.
  • Drop your stand-alone Medicare Part D Prescription Drug Plan.

You can learn more about the advantages and disadvantages of these changes on the Medicare website.

Pricing Changes

Most plans will experience a slight increase in deductibles and coinsurance, as is typical for a new fiscal year. In addition, Medicare Advantage pricing will require some slight changes to factor in the costs of new service.

At first, Medicare Advantage plans might seem more affordable than Original Medicare, but once you factor in the cost of Part D and supplemental policies, it can be more expensive. Additionally, you may be subjected to a more restricted providers network. Discuss your options with an experienced insurance agent to help you determine how pricing changes will affect you.

Overall, Receive Better-Managed Care

All of the changes being applied to Medicare Advantage programs are done in the name of better-managed care. Public health experts, families, doctors, and patients have long bemoaned the outdated form of healthcare that involves paying for treatments only, even if those treatments aren’t extremely effective.

With better-managed care programs through Medicare Advantage, patients will get the treatment they need, regardless of their financial situation. They’ll be able to stay in their homes for longer and enjoy more personalized care while preventing serious injuries and maintaining a longer record of good health. It’s the first of many strides in the right direction for Medicare Advantage members.

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