This post was originally published on May 23, 2018; updated 8/1/18
CMS is passing regulations that will allow Medicare Advantage plans to offer more unique benefits. The goal is to make it easier for seniors to keep living at home. CMS administrator Seema Verma said, “Medicare Advantage beneficiaries will have more supplemental benefits, making it easier for them to lead healthier, more independent lives.”
Even without any expansion, Medicare Advantage has been steadily growing in popularity over the past few years. It’s the most logical option for beneficiaries with chronic illnesses and disabilities because MA plans typically cover much more hospital costs and ancillary services than Original Medicare. Plus, beneficiaries need the prescription drug coverage that MA provides.
This year, 87% of Medicare beneficiaries have access to at least one Medicare Advantage plan. A total of 33% of all Medicare beneficiaries are enrolled in a Medicare Advantage plan, and studies suggest that the number will continue to rise.
Early this year, CMS released new changes regarding Medicare and Medicaid benefits. One of the biggest and newest changes is increased flexibility in what Medicare Advantage plans are allowed to offer as “supplemental” Medicare benefits.
Keeping up with modern technology and the popularity of ridesharing services, Medicare Advantage plans can now include more transportation options to help seniors get to and from doctor’s appointments. Meal delivery services for those who have a hard time shopping for groceries or cooking for themselves are also allowed – and we are already seeing plans add these to their list of benefits.
New Durable Medical Equipment laws will also allow Medicare Advantage plans to allow home modifications, like wheelchair ramps for homes with stairs or air conditioners for those with asthma. Plans will also likely allow for more home health care to help with dressing, eating, etc, as well as more access to telehealth for those who have trouble accessing doctors.
Opioid misuse grows every year; it’s impossible for CMS to ignore it. In 2019, CMS is asking Part D sponsors to limit opioid prescription refills and allow no more than a seven-day supply at one time. Additionally, CMS is expanding the Overutilization Monitoring System (OMS) to help identify beneficiaries who are using high levels of opioids from multiple pharmacies and with multiple prescriptions. When those beneficiaries are found, Part D sponsors must perform case management and can limit prescriptions.
Sponsors are also expected to implement safety alerts when chronic opioid users submit a prescription. CMS will start urging Part D sponsors and MAPD plans to set certain expectations for opioid prescriptions. Otherwise, beneficiaries will likely be stopped at the point-of-sale.
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