In 2020, Medicare beneficiaries will have more opportunities to join Medicare Advantage (MA) managed care plans that offer limited personal supports and services such as home care, non-medical transportation, nutrition programs, and home modifications. The benefits, first allowed by the federal government for 2019, are not full-blown long-term care, but they do provide critical services and supports that may make it easier for older adults with chronic conditions to stay in their homes.
Enrollment for 2020 begins on Oct. 15 and runs through December 7. Medicare participants will pay no additional premiums for the additional benefits, nor will Medicare pay the plans extra money to run the programs. Plans expect that providing the additional services eventually will lower enrollees’ use of high-cost medical care such as hospital stays.
Return on investment
While that return on investment remains uncertain, plans seem more enthusiastic about adding the benefits for 2020. The Centers for Medicare and Medicaid Services (CMS) estimates that about 500 plans will offer about 2.6 million enrollees health-related supplemental benefits such as adult day programs or caregiver supports. About 250 plans will offer non-medical supplemental benefits to about 1.2 million enrollees. These include services ranging from rides to the grocery store to pest control.
The expansions are the result of two parallel changes in the law enacted in 2018. CMS adopted new rules (revised for this year) that allowed plans to offer additional “primarily health-related” supplemental medical benefits that maintain or improve overall health. At about the same time, Congress adopted the CHRONIC Act, a law that allowed plans to offer non-medical services to members with chronic conditions. The new law also gave plans important flexibility that makes it possible for them to tailor benefits to people with specific needs. For instance, plans could offer nutrition coaching to members with diabetes without having to offer similar services to all its members.
Modest extra benefits
The extra benefits are very modest. Independent analysts estimated that were worth only $30-$50 a month in 2019, and they are unlikely to be much higher in 2020. Crucially, however, they begin to break down the half-century barrier between health care, which Medicare does pay for, and supports and services, which it generally does not.
One early adopter of the MA expansion was Anthem, a managed care unit of Blue Cross. This year, it offered supportive services in about a dozen states, but in 2020 it is expanding the programs to 16 states. It also is increasing the kinds of services it offers. And it expects to roughly double the number of enrollees eligible for the added benefits.
Anthem offers two basic benefit packages. In the version most widely available, members choose in advance one benefit from a menu of services such as transportation, alternative medicine, in-home supports, and the like. In the other, much smaller alternative, participating members have access to all available services. Members can use an Anthem case manager to help make their choices.
The most popular benefits for 2019: Transportation and alternative medicine such as massage therapy. For next year, Anthem is adding services such as nutritional counseling, home delivery of food staples, pest control, and even support for service animals.
More experience needed
Anthem was pleasantly surprised by the number of members who enrolled for 2019—about 165,000 signed up for the pick-from-the-menu version and about 65,000 for the full suite of services. And while some analysts feared that only the highest risk seniors would enroll in the program, Anthem found that was not the case. The risk profile of those receiving supplemental benefits was similar to overall MA enrollees.
One year of experience was not enough for Anthem to conclude that the new social supports will reduce medical costs or improve outcomes for the participating members. Yet, the results were positive enough that the insurer expanded the program for 2020. Anthem’s vp of product design, Martin Esquivel, calls the overall 2019 experience “quite fruitful.”
Other plans are enhancing MA benefits as well. Cigna, which is expanding its overall MA business, will offer benefits such as non-medical transportation services in Arizona and Pennsylvania. The Pittsburgh-based UPMC Health Plan will offer members with diabetes special health coaching.
Overall, about one-third of Medicare beneficiaries are enrolled in MA plans this year. CMS announced in late September that average 2020 premiums are expected to decline to $23 from $26.87 in 2019. CMS projects about 24.4 million people will enroll in MA plans next year, up from 22.2 million this year.
It will take a few more years for consumers, plans, and policymakers to learn how well the model works, and whether it can both save plans money and improve health outcomes for members. But, at least for now, this important experiment appears to be growing.