New Medicare Advantage Benefits May Be Hard to Find – and Qualify For

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In 2019, expanded benefits for Medicare Advantage were enabled, but so far few providers offer them.

The annual open enrollment season (Oct. 15, Dec. 7, 2007) is the best time to take advantage of the new Medicare Advantage benefits. It might not be easy to find a plan that offers these benefits.

Medicare Advantage, also known as Medicare Part C, is administered by private insurers and offers the same Medicare Part A and Part B benefits as Original Medicare. Some plans include limited hearing, vision, and dental coverage.

New government rules allow Medicare Advantage plans to increase benefits further starting in 2019. Often referred to as Special Supplemental benefits for the Chronically Ill (SSBCI), these new benefits can provide more than just medical care. They can also offer support that can prolong or improve a person’s life.

Government research shows that more than 70% of seniors live with at least one chronic illness, although eligibility rules for the new benefits also require “a high risk of hospitalization or other adverse health outcomes.”

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These new rules allow for coverage for adult care services, home-based Palliative Care, in-home support services and caregiver support.

It’s great to have additional support for older adults who are chronically ill. These supplemental benefits can be very helpful, but they are only that, a supplement. The provider has the ability to decide which benefits to offer and they are not available to all members of a particular plan.

Insurers and consumers have so far been slow to adopt the new rules. According to Brown University research, only 4.6% of plans offer any new benefit. This was according to May 2020 Brown University research.

David Lipschutz, senior policy attorney and associate director at the Center for Medicare Advocacy, advises that you should be aware of the limitations before you sign up for these expanded plans. Here are some things to remember.

Learn what is being offered

Benefits may not be available to everyone

Lipschutz explains that the new rules include a change to the so-called “uniformity rule”. Medicare Advantage plans used to provide the same benefits to everyone who was enrolled in their plan. This was usually for those living in a particular area or county. So, if you’re eligible for twice-yearly dental checkups under your plan, so is everyone else enrolled in the plan.

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Insurers determine who is eligible for SSBCI benefits. Grab bars may not be available to patients who have fallen in the past. Patients with dementia may only be eligible for memory care.

It can be difficult to know if you are eligible

Before you enroll in a plan offering them, you won’t be able to know what, if any, benefits you will receive. This is because the plan will need your diagnosis to determine if you are eligible for the plan. This cannot be done before you become a member.

Comparing plans becomes difficult because of this. Using Medicare.gov’s Plan Finder tool, you can determine what benefits are offered, but not if you will qualify. Remember that agents, brokers, or anyone representing a plan cannot guarantee your eligibility. Lipschutz says that even if a customer service representative answers the phone for an insurer, this does not mean that they can guarantee your eligibility.

Limits

Each plan can decide how much of a benefit it will cover. Lipschutz says that most benefits are very limited. Meal delivery services may only be available once per day for a limited time. The number of visits to home-health aides can be limited to 12 per year.

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Check the “Evidence of Coverage”, which outlines coverage details, to find out how your plans limit supplemental benefits. This document can be found on the insurer’s site or, more often, via a link in Medicare.gov’s Plan Finder.

You can make a change in your mind

If you find you’ve enrolled in a Medicare Advantage plan and you aren’t happy with it for whatever reason, you can change to another Medicare Advantage plan during the three-month Medicare Advantage open enrollment period starting Jan. 1 and ending March 31. If you sign up for a plan for the supplemental benefits, but later discover that you are not eligible for them, this can be useful.

This special enrollment period is limited to one change of plan. This is in contrast to the end-of-2018 open enrollment period (Oct.15 – Dec.7), where you can move between plans as many times as you wish.