Medicare Advantage plans have started offering new supplemental benefits that are not directly considered medical treatment. Some plans are now starting to offer coverage for services such as nutrition counseling, in-home support, and home modifications.
This means that if you have a chronic illness, your Medicare Advantage insurer may be able to offer more non-medical assistance than before to help you manage the illness and improve your overall health.
Medicare Advantage plans have been able to offer supplemental benefits for a few years, but the breadth of those offerings are expanding as a result of regulatory changes by the Centers for Medicare and Medicaid Services (CMS) and new rules enacted by the 2018 budget.
The new rules for plan years 2019 and beyond will change the scope of benefits that insurers are allowed to offer as supplemental benefits.
The CMS requires that Medicare Advantage supplemental benefits:
- Not be covered by Original Medicare,
- Be primarily health-related, and
- Require the MA plan to incur a non-zero direct medical cost.
In its Call Letter for 2019, the CMS reinterpreted its definition of “primarily health-related.” While the prior definition only allowed benefits that “supplemented, cured, or diminished an illness or injury,” the new definition added the following language:
“[A primarily health-related benefit] must diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization.”
The Call Letter further cited examples of new benefits that are now eligible under this new definition. Below is a list of these new benefits.
Assistance with activities of daily life
This includes items and services for enrollees who have been diagnosed with needing assistance with activities of daily living.
This could include everything from safety equipment, hand rails, and permanent ramps, to the widening of hallways or doorways if those items and services have a reasonable expectation of improving or maintaining the health or overall function of the enrollee as it relates to the chronic condition or illness.
Non-opioid pain treatment
Medicare Advantage plans will also be able to provide medically approved non-opioid pain treatment alternatives as supplementary benefits, including:
- Therapeutic massage
- Acupuncture
- Peer support services
- Fitness benefits
- Chiropractic services
- Similar services
Transportation
Another supplementary benefit that Medicare Advantage plans could start offering is transportation to obtain non-emergency and supplemental benefit items and services to accommodate the enrollee’s health care needs.
Essentially, this change has opened the doors for Medicare Advantage plans to begin offering medical transportation benefits to their members. It further emphasizes that transportation can be used not only for critical care services, but also for preventative services, trips to massage therapy, and other wellness visits.
What’s next?
These changes mean that there may be more Medicare Advantage plan options available going forward, and it may become more complicated to compare these options.
Some Medicare Advantage plans have already started changing their supplementary benefit offerings. When your next renewal is coming up, review your Medicare Advantage plan’s Evidence of Coverage and any other materials from the insurer.
Need help understanding your benefits or coverage?
Contact us. One of our consultants will be happy to help you.
Catherine oversees UBF's daily operations and client retention strategy. She has a background in mathematics, economics, and human resources. In her spare time, she enjoys spending time with her family, taking the dog on long walks, and caring for a small and unfruitful garden.
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