CMS Allows Medicare Advantage Plans to Expand

Published July 1, 2019

Some of the new benefits might include transportation, adult day care, caregiver support services, home meal deliveries, home environmental improvements, and in-home support services. The new rule, announced in April, goes into effect next year.

CMS says the change will give “chronically ill patients with Medicare Advantage the possibility of accessing a broader range of supplemental benefits that are not necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees.”

According to CMS, Medicare Advantage has grown in popularity and scope and has a high satisfaction rate, with premiums the lowest they’ve been in six years. The plans are a private insurance alternative to Medicare’s traditional fee-for-service model. According to the Kaiser Family Foundation, 34 percent of Medicare enrollees are using Medicare Advantage, a percentage that has doubled in the last ten years.

Ready to Go

One Medicare Advantage provider says the change to allow broader benefits is a step in the right direction.

“We believe that for health care to get smarter, health plans need to figure out how they can personalize coverage better for each member,” says Tami Hibbitts, vice president of senior markets for Priority Health, a Medicare Advantage provider in Michigan.

Priority Health has been participating in Medicare Advantage for 15 years, and it is growing in popularity.

“In Michigan, overall, original Medicare enrollments are decreasing year by year, while Medicare Advantage enrollments are increasing,” said Hibbitts. “We expect this trend to continue as products become more desirable with the unique supplemental benefits health plans Priority Health [is already] offering.”

Spreading Success

John C. Goodman, founder, president, and CEO of The Goodman Institute, a public policy organization that champions free-market health care solutions, says the federal government should do more to allow seniors to benefit from Medicare Advantage.

“A study published in Health Affairsfinds that the Medicare Advantage program costs less and delivers higher quality care than traditional Medicare,” said Goodman.

“Within the Medicare Advantage program, the most successful plans are the ones administered by independent doctors’ associations,” said Goodman. “These plans are showing that integrated care, coordinated care, medical homes, and electronic information sharing actually work to keep patients healthier and improve medical outcomes.”

Goodman says private-sector plans available through Medicare Advantage far outperform traditional, government-run Medicare.

“The most successful part of Medicare is run by private insurers,” Goodman said. “These private plans are virtually indistinguishable from the private insurance non-seniors have.”

Jeff Reynolds ([email protected]writes from Portland, Oregon.


Internet Info:

Primary Care Physician Networks in Medicare Advantage, April 2019, Yevgeniy Feyman, Jose Figueroa, Daniel Polcky.