The Medicare Advantage Managed Care plan, which covers 26 million enrolled by 2021, will see an average 8.5 percent increase in total Medicare payments next year.
At the same time, MA plans are rapidly embracing a wide range of social services and helping older adults living at home. Sometimes called long-term care lights, these benefits range from food and food supplies to transportation, home changes and adult daycare.
A new report from the Long-Term Care Quality Alliance (LTQA) and consulting firm ATI Advisory found an explosion of interest in plans to offer these non-medical benefits. The survey found that about one-third of all plans – more than 1,800 in all – are offering some of these additional benefits in the 2022 plan, more than tripling the 2020 number.
LTQA and ATI estimate that 98 percent of MA enrollers have access to a plan that offers some of these benefits. About 7 million people are enrolled in plans that offer complementary benefits.
Expansion of facilities
These new benefits are approved under multiple, highly complex federal regulations. In 2019, the Center for Medicare and Medicaid Services (CMS) redefined “primarily health-related” benefits to include some assistance called the extended primarily health-related facility (EPHRB). These include daily health care for adults, home-based palliative care, family care support and certain in-home support services.
In 2020, Congress enacted the Chronicle Act, which primarily allowed plans to be offered for health-related special complementary benefits for the Chronicle Ill (SSBCI). These include food and food supplies, non-medical transportation, home relocation, general care for home care and even pest control. There are other avenues for these benefits.
Importantly, plans may target these new benefits for individual registrants, whether they need them or not, rather than providing the same benefits to each member.
Plans provide most of the services they receive from Medicare to provide effective care. Since these extra payments are relatively modest, the value of the support services they offer is equally modest, usually $ 50 / month or less.
ATI research shows how plans have begun to adapt to the services they offer For example, in 2022, seven times more meals were delivered and 6 times more meals were delivered than in 2020. The number of non-medical transport plans has tripled.
At the same time, the number of plans for the year 2022 to provide therapeutic massage and adult healthcare has declined – most likely because the epidemic has severely reduced these services until recently.
A black box
However, there is no need to plan how many Medicare members actually benefit. And the plans themselves will not disclose this information. So, at least for now, these benefits are something of a black box. There is no way to know how profitable these services are for planning or whether they really benefit their members.
Health and long-term care experts have long speculated that social services and personal care for vulnerable adults could reduce preventable illness or injury and thus reduce medical costs. This is important for MA plans, which are paid a monthly fee per member by Medicare (usually around $ 1,000), but are completely risky for their members’ medical expenses.
Since even a brief hospital admission can consume a year’s worth of Medicare payments, there is a strong impetus for plans to keep their members as healthy as possible. And their published choices therefore show that complementary benefits reduce those medical costs.
Not long term care
According to a news agency analysis, six insurers: UnitedHealth, Humana, CVS, Anthem, Centene and Cigna— are responsible for about half of all MA enrollment. Axios. However, many younger players see the opportunity and try to enter the MA business. Together, these insurance companies operate thousands of personal plans across the country. More than 40 percent of Medicare registrants are now members of the MA plan.
The support services that today’s plans offer should not be completely confused with long-term care. A monthly benefit of $ 40 or $ 50 is much less than a $ 200-day long-term care insurance benefit that a home care assistant can pay for seven hours. And MA benefits are only available to people living at home. They do not cover nursing home care.
But this alphabet soup of new benefits is beginning to pave the way for Medicare to provide personal care for the chronically ill. Lawmakers are already discussing the idea of a more flexible, and perhaps more liberal, Chronicle Act 2.0.
And, at least theoretically, MA plans can offer much more robust, premium-based, long-term care coverage. No one for now. But they could.
This leaves one more big open question: will the government find a way to provide these benefits through traditional Medicare?
Full disclosure: I serve as an unpaid member of LTQA’s advisory panel on MA supplementary benefits.