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Valued Social Butterfly

Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 1 of 10

@GailL1 wrote:

The article I just quoted was FROM THE AARP.

This, thus far, isn't about any specific questions - the plans with any new extra benefits will not be out until open enrollment starts in the fall of this year for plans effective in 2019.

 

 


Put away the articles for 12 months. Go out and help some people in your area that need it.

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Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 2 of 10

The article I just quoted was FROM THE AARP.

This, thus far, isn't about any specific questions - the plans with any new extra benefits will not be out until open enrollment starts in the fall of this year for plans effective in 2019.

 

 

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Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 3 of 10

@GailL1 wrote:

john258 - That AARP post you are referring to "above" is a "sticky" about Open Enrollment for 2018 - see the date it was posted  10/18/2017 By administrator Sandi.

 

The "sticky" note has nothing to do with these new extra benefits - however the AARP article from Feb 2018 which I linked in this thread and again below, is talking about these new type extra benefit offers from MA plans for 2019; the article was written before the approval given in April 2018.

 

For your convenience, as well as others, I am posting it here in its entirety.  Maybe it will open up some discussion.

 

AARP 02/05/2018 - Medicare Advantage Plans May Expand Benefits

 

Next year the federal government plans to allow Medicare Advantage plans to cover items and services such as portable wheelchair ramps and “other assistive devices and modifications” that help people who have suffered falls, injuries or have other physical impairments.

 

“We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage (MA) plans to offer new health-related benefits,” Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), said in her announcement of the new policy.


The goal in allowing these new benefits is to diminish the impact of injuries or health conditions as well as prevent falls and other incidents that require trips to the emergency room. Although Medicare pays for wheelchairs, walkers and canes, it does not currently cover things like grips or portable chairs in a shower or modifications to homes, such as widening a door for wheelchair access.

 

MA plans are currently allowed to offer supplemental benefits not covered by traditional Medicare, such as dental, vision and hearing. Traditional Medicare does not cover such additional services and that has some Medicare advocates concerned about this policy change.

 

The initial impulse is this is great and these things should be covered,’’ says David Lipschutz, senior policy attorney at the Center for Medicare Advocacy. “But we would hope these things would be available to all Medicare beneficiaries. This continues to tip the scale in favor of Medicare Advantage over traditional Medicare.”

 

About one-third of all Medicare beneficiaries are enrolled in Medicare Advantage plans. According to CMS, the number of MA plans available across the country increased from about 2,700 in 2017 to more than 3,100 for 2018.

 

CMS noted that MA plans could not use the new benefits “solely to induce enrollment.” In addition, the services must be ordered by a licensed provider and focus directly on an enrollee’s health care needs.

 

But Lipschutz questions how federal officials would police these rules. “We want people who need these things to get them,” Lipschutz says. “But who is getting it and not getting it is part of the story.”

 

Public comments on the proposal will be accepted until March 5. CMS plans to announce the final rule on April 2.

 

 

 


I do not need your long articles as they are a waste of time. Her post came right after yours and the places she points out are were people should go if they have questions. The one place they should not go is articles like you post. The best place is AARP or a local expert.

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Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 4 of 10

john258 - That AARP post you are referring to "above" is a "sticky" about Open Enrollment for 2018 - see the date it was posted  10/18/2017 By administrator Sandi.

 

The "sticky" note has nothing to do with these new extra benefits - however the AARP article from Feb 2018 which I linked in this thread and again below, is talking about these new type extra benefit offers from MA plans for 2019; the article was written before the approval given in April 2018.

 

For your convenience, as well as others, I am posting it here in its entirety.  Maybe it will open up some discussion.

 

AARP 02/05/2018 - Medicare Advantage Plans May Expand Benefits

 

Next year the federal government plans to allow Medicare Advantage plans to cover items and services such as portable wheelchair ramps and “other assistive devices and modifications” that help people who have suffered falls, injuries or have other physical impairments.

 

“We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage (MA) plans to offer new health-related benefits,” Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), said in her announcement of the new policy.


The goal in allowing these new benefits is to diminish the impact of injuries or health conditions as well as prevent falls and other incidents that require trips to the emergency room. Although Medicare pays for wheelchairs, walkers and canes, it does not currently cover things like grips or portable chairs in a shower or modifications to homes, such as widening a door for wheelchair access.

 

MA plans are currently allowed to offer supplemental benefits not covered by traditional Medicare, such as dental, vision and hearing. Traditional Medicare does not cover such additional services and that has some Medicare advocates concerned about this policy change.

 

The initial impulse is this is great and these things should be covered,’’ says David Lipschutz, senior policy attorney at the Center for Medicare Advocacy. “But we would hope these things would be available to all Medicare beneficiaries. This continues to tip the scale in favor of Medicare Advantage over traditional Medicare.”

 

About one-third of all Medicare beneficiaries are enrolled in Medicare Advantage plans. According to CMS, the number of MA plans available across the country increased from about 2,700 in 2017 to more than 3,100 for 2018.

 

CMS noted that MA plans could not use the new benefits “solely to induce enrollment.” In addition, the services must be ordered by a licensed provider and focus directly on an enrollee’s health care needs.

 

But Lipschutz questions how federal officials would police these rules. “We want people who need these things to get them,” Lipschutz says. “But who is getting it and not getting it is part of the story.”

 

Public comments on the proposal will be accepted until March 5. CMS plans to announce the final rule on April 2.

 

 

 

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Valued Social Butterfly

Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 5 of 10

@GailL1 wrote:

@john258 wrote:

AARP posted how Seniors can get good information on the subject. It was right after your long confusing post.  Now you will not have to post again on the subject just refer Seniors to AARP post.

Well, it would be extremely helpful if you would post a link to the AARP information.  Can you, will you?

 

The only one I could find was the one back in 02/2018 before it was finalized.

AARP 02/2018 - Medicare Advantage Plans May Expand Benefits


Well go back to the form you posted this article in. Medicare & Insurance. The next topic above yours is from Sandy of AARP and she list places where Seniors should go for advice. Looks like she read your post and took action. I gave her a kudo.

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Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 6 of 10

@john258 wrote:

AARP posted how Seniors can get good information on the subject. It was right after your long confusing post.  Now you will not have to post again on the subject just refer Seniors to AARP post.

Well, it would be extremely helpful if you would post a link to the AARP information.  Can you, will you?

 

The only one I could find was the one back in 02/2018 before it was finalized.

AARP 02/2018 - Medicare Advantage Plans May Expand Benefits

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Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 7 of 10

@GailL1 wrote:

@john258 wrote:
 

Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

 

READ MORE AT THE ABOVE LINK -

 


Looks like it was bad in April so give it a try in July. What is the premium being paid by Medicare to the Carriers to offer their programs now. It was about 15% at the start and was to be done away with.  We were all paying higher costs so some could have Medicare Adv, programs. One thing you left out most of the benefits you talk about were being used the by the carriers for all their Group policies so it was no big deal. A number of them were discount programs like a lot of the gym memberships  which cost the carrier nothing.


Any new plan offerings will not happen until the Open Enrollment for 2019 selection.  

 

I reposted it just so seniors could be informed about it for their next enrollment as my post indicated.

 

Medicare (CMS) does not include any extra benefit design offered in their payment to MA plans, never have - the formula used is based on a benchmark plan in their general geographical location.

 

As people here have posted on the advantages of offering some type of exercise program for their general health and wellbeing, their desire to have it, how this might affect their selection of a MA plan and how they have been positively or negatively influenced by the offering, I will have to assume that other added benefits will be considered by some of them under the same scrutiny.

 

I, like you, do not know what might be included in these extra benefits designed by the insurers, but see some possibilities which could help seniors in keeping or improving their health -

 

Like I said, it is interesting and if these extra benefit design plans are desirable to seniors, MA plans could begin to get even more market share in Medicare because in the final measure, each senior has to determine what is best for them.

I see many possibilities so seniors do need to scrutinized all plans available to them and their benefit to them, as always, during open enrollment periods.

 

"CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.".  

Personally,  that does seem to be somewhat of an oxymoron because depending upon ones health and health priorities at the time the annual selection is made, the senior, themselves, may consider these to be of high value.

 

They should remember that since these are extra and not required by CMS that they could change; any extra benefits should also be covered in writing in their benefit design; they should also understand how these (any) extra benefits are covered in the plan.  They should also consider that once a MA plan is chosen and they are past the initial (at 65) enrollment or any applicable guaranteed issue special rules that moving back to original Medicare with a selection of a Medigap plan could present difficulties or extra cost down the road.


AARP posted how Seniors can get good information on the subject. It was right after your long confusing post.  Now you will not have to post again on the subject just refer Seniors to AARP post.

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Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 8 of 10

@john258 wrote:
 

Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

 

READ MORE AT THE ABOVE LINK -

 


Looks like it was bad in April so give it a try in July. What is the premium being paid by Medicare to the Carriers to offer their programs now. It was about 15% at the start and was to be done away with.  We were all paying higher costs so some could have Medicare Adv, programs. One thing you left out most of the benefits you talk about were being used the by the carriers for all their Group policies so it was no big deal. A number of them were discount programs like a lot of the gym memberships  which cost the carrier nothing.


Any new plan offerings will not happen until the Open Enrollment for 2019 selection.  

 

I reposted it just so seniors could be informed about it for their next enrollment as my post indicated.

 

Medicare (CMS) does not include any extra benefit design offered in their payment to MA plans, never have - the formula used is based on a benchmark plan in their general geographical location.

 

As people here have posted on the advantages of offering some type of exercise program for their general health and wellbeing, their desire to have it, how this might affect their selection of a MA plan and how they have been positively or negatively influenced by the offering, I will have to assume that other added benefits will be considered by some of them under the same scrutiny.

 

I, like you, do not know what might be included in these extra benefits designed by the insurers, but see some possibilities which could help seniors in keeping or improving their health -

 

Like I said, it is interesting and if these extra benefit design plans are desirable to seniors, MA plans could begin to get even more market share in Medicare because in the final measure, each senior has to determine what is best for them.

I see many possibilities so seniors do need to scrutinized all plans available to them and their benefit to them, as always, during open enrollment periods.

 

"CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.".  

Personally,  that does seem to be somewhat of an oxymoron because depending upon ones health and health priorities at the time the annual selection is made, the senior, themselves, may consider these to be of high value.

 

They should remember that since these are extra and not required by CMS that they could change; any extra benefits should also be covered in writing in their benefit design; they should also understand how these (any) extra benefits are covered in the plan.  They should also consider that once a MA plan is chosen and they are past the initial (at 65) enrollment or any applicable guaranteed issue special rules that moving back to original Medicare with a selection of a Medigap plan could present difficulties or extra cost down the road.

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Re: Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 9 of 10

@GailL1 wrote:

I posted this back in early April 2018 but wanted to post it again just in case somebody wants to look specifically into any of these new benefits which they might need and are being offered by a Medicare Advantage insurer at open enrollment.

 

Kaiser Health News 04/03/2018 - Medicare Advantage Plans Cleared To Go Beyond Medical Coverage - Eve....

 

These NEW supplemental benefits to encourage and help seniors lead healthy or healthier lives should begin to show up in the plans that will be offered later this year.  

 

The Centers for Medicare & Medicaid Services (CMS) expanded how it defines the “primarily health-related” benefits that (private) insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers.

 

Medicare Advantage beneficiaries will have more supplemental benefits making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma.

 

Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits.

 

Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.

 

CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.

 

. . . . Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.

 

Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

 

READ MORE AT THE ABOVE LINK -

 


Looks like it was bad in April so give it a try in July. What is the premium being paid by Medicare to the Carriers to offer their programs now. It was about 15% at the start and was to be done away with.  We were all paying higher costs so some could have Medicare Adv, programs. One thing you left out most of the benefits you talk about were being used the by the carriers for all their Group policies so it was no big deal. A number of them were discount programs like a lot of the gym memberships  which cost the carrier nothing.

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Medicare Advantage Plans Cleared To Go Beyond Medical Coverage

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Message 10 of 10

I posted this back in early April 2018 but wanted to post it again just in case somebody wants to look specifically into any of these new benefits which they might need and are being offered by a Medicare Advantage insurer at open enrollment.

 

Kaiser Health News 04/03/2018 - Medicare Advantage Plans Cleared To Go Beyond Medical Coverage - Eve....

 

These NEW supplemental benefits to encourage and help seniors lead healthy or healthier lives should begin to show up in the plans that will be offered later this year.  

 

The Centers for Medicare & Medicaid Services (CMS) expanded how it defines the “primarily health-related” benefits that (private) insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers.

 

Medicare Advantage beneficiaries will have more supplemental benefits making it easier for them to lead healthier, more independent lives,” said CMS Administrator Seema Verma.

 

Of the 61 million people enrolled in Medicare last year, 20 million have opted for Medicare Advantage, a privately run alternative to the traditional government program. Advantage plans limit members to a network of providers. Similar restrictions may apply to the new benefits.

 

Many Medicare Advantage plans already offer some health benefits not covered by traditional Medicare, such as eyeglasses, hearing aids, dental care and gym memberships. But the new rules, which the industry sought, will expand that significantly to items and services that may not be directly considered medical treatment.

 

CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care.

 

. . . . Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.

 

Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

 

READ MORE AT THE ABOVE LINK -

 

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