Medicare Advantage Plans Could Cover More than Just Medically Necessary Benefits

Original Medicare and Medicare Advantage Plans

Historically, original Medicare and the replacement plans known as Medicare Advantage plans have only covered medically necessary hospital and Medical benefits with some Medicare Advantage plans covering limited preventative dental and vision benefits.  All that could change in 2020 as new Medicare rules will allow some Medicare plans to integrate various short term custodial care plans within their benefit structure.

Officials at Center for Medicare/Medicaid benefits are giving insurers direction on how to place short term care benefits within their Medicare Advantage plans next year.  Officials hammered out the rules for SSBCI (Special Supplemental Benefits for the Chronically Ill) in a draft letter call for the 2020 bidding process with Medicare and will allow insurers to integrate these benefits from the start of 2020.

Medicare Advantage Plan Basics

Medicare Advantage plans, otherwise known as Medicare Part C plans, combine Hospital, Medical, and prescription coverage into one policy and work as a “Private” alternative to Original Medicare.  There are about 22 million seniors under Medicare Advantage plans as opposed to those still under the original fee for service model for Medicare.

These Advantage plans can offer additional benefits not offered under original Medicare like Dental, Vision, and now short term custodial care.  Original Medicare still does not offer these additional benefits and this proposal will not add any new benefits for short term care or dental and vision under original Medicare.

Where Medicaid Comes In

Traditionally Medicaid, which receives federal and states dollars to provide Medicare benefits to the poor and long term care benefits for impoverished individuals, has paid for these services.  In the past Medicare has only covered medically necessary services and not covered custodial care not directly related to Medical care, such as meal preparation, transportation, cleaning or grocery shopping.  In 2019, CMS began allowing insurers to add this type custodial care into their Advantage plans and some carriers have added small amounts of adult day care into their policies for example.

Taking a Look at Your Benefits

If you have a Medicare Advantage plan you might want to take a second look at your line up in Open Enrollment 2019 to see if any of these additional benefits will be added to your plan or, if there are other plans in your area that might have some of these benefits built into the plan.  

Many seniors who have surgeries like knee and hip replacements might be well enough to exit the hospital but not well enough to take care of their physical needs like buying groceries, cleaning the house, feeding animals, or bathing themselves. This is where these short term plans can really come in handy and save you a lot of money should you need them as original Medicare does not currently cover this type of “non-medical” care.

These short term care plans are ideal particularly if you decided to put off the purchase of long term care or decided it was too costly.  These short term plans are a fraction of the cost of traditional long term care insurance and easier to get. The underwriting requirements with these plans are minimal and usually amount to a series of health questions on an application for insurance.  

Learning More About Short-Term Custodial Plans

So, if you have a Medicare Supplement with original Medicare or an advantage plan and would like a quote or need to learn more about these short term custodial plans, please give our office a call to speak with one of our licensed and AHIP certified agents at: 855 248 0247.  Or you may complete a contact form and request a brochure or outline of coverage from one of our licensed representatives at no obligation through our website at: https://ihsinsurance.net/get-a-quote/

I H S Insurance Group is an independent agency with an office located in Tomball, TX.  We currently have licenses to transact health and life insurance policies in the following states: Texas, Oklahoma, New Mexico, Tennessee, Virginia, Arkansas, Louisiana, Florida, Missouri, and Arizona.  We hope you found this information useful and do not hesitate to reach out to us if you need any clarification.

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