Medicare Advantage plans don’t include benefits to pay for assisted living expenses. However, as of 2020, some Advantage plans will consist of benefits for some long-term care services.
Back in 2018, there was new legislation passed that allowed Advantage plans to include benefits for supplemental home care services for chronically ill beneficiaries.
Long-term care benefits vary by plan and locality. These extra benefits may include nutrition services, home safety modifications, and adult daycare.
We’ll go over the specifics below as well as compare the differences in benefits between Traditional Medicare and Medicare Advantage when it comes to long-term care.
Explanation of Traditional Medicare and Long-Term Care Benefits
Inpatient care benefits that fall under Part A, such as acute hospital care, skilled nursing care, and hospice benefits, were designed to help those beneficiaries that were on their way to recovery. Coverage is limited and only available on a short term basis.
Skilled nursing facility care falls under Part A. These benefits are capped at 100 days. After you’ve reached 100 days, you’re responsible for 100% of the costs.
Explanation of Medicare Advantage and Long-Term Care Benefits
Since Medicare Advantage plans are required to have the same benefits as Original Medicare, these policies also cover up to 100 days in a skilled nursing facility.
Advantage plans also include additional benefits such as routine vision and dental care. Starting in 2020, some Advantage plans will now include benefits for some supplemental home care services.
These supplemental services could allow beneficiaries to continue living independently vs. transitioning into a full-time assisted living facility. It’s up to the Advantage carrier if they want to include these supplemental home care services as part of the plan’s benefits.
Next, we’ll go over what types of supplemental home health services you could start seeing added to some Advantage plans this year.
Adult Day Care Services
You can expect to see some carriers adding adult day care services to their plan benefits. Adult daycare provides a stimulating and social environment while giving regular caregivers some time for themselves. Some adult daycare centers even offer memory care. Policies may limit the number of days or the frequency of adult daycare use.
In-Home Personal Care Services
As people age, they may need assistance with daily activities such as eating, dressing, going to the bathroom, bathing, etc. When you need help with everyday activities, it’s usually time to start considering long-term care.
However, beneficiaries may be able to delay moving into a long-term care facility if they have home health aid to help them with these daily activities. Some Advantage plans will now be including in-home support services in their benefits.
Telehealth is helpful to those having a hard time getting to the doctor’s office. Advantage carriers are now including Telehealth services as part of their plan’s benefits. These Telehealth services allow beneficiaries to attend their doctors’ appointments over a video conference call using a smartphone or computer.
Allowance for Over the Counter Products
Advantage plans will now be able to include benefits for over the counter products such as allergy medications, daily supplements, cold and flu medications, etc. Beneficiaries will have a monthly or quarterly allowance that the carrier sets.
Home Safety Modifications
Once a beneficiary starts having a hard time moving around or maybe experiences a bad fall, they start considering transitioning into an assisted living facility. The good news is, Advantage plans will now begin including benefits for home safety modifications and improvements.
Examples of these modifications and improvements include grab bars for bathrooms or wheelchair ramps. These modifications can help reduce the number of medical emergencies as well as allow the beneficiary to delay the need to transition into assisted living.
Transportation & Meal Delivery
With the popular demand for transportation services and meal delivery, Advantage plans will now include benefits for both. These transportation services will help beneficiaries attend their doctors’ appointments as well as pick up medications from their local pharmacy. They may also include benefits for grocery delivery services.
Prevention Before Treatment Reduces Expenses
Thankfully, the healthcare industry is starting to see the benefits of prevention vs. treatment. Instead of only treating those who are ill, they are switching their focus to prevention.
Carriers are concluding that early prevention can reduce medical spending over-time and improves over-all patient outcomes.
How to Prepare for Long-Term Care Costs
As of now, we don’t foresee Medicare or Medicare Advantage plans including benefits for nursing home care or assisted living facilities. Therefore, planning for longterm care costs before retirement should be top of mind.
An option is to purchase a long-term care insurance policy or setting up a bank account to cover these expenses. If you don’t medically qualify for long-term care insurance, you may be eligible for Medicaid once you’ve depleted your assets.
Medicare Advantage and Assisted Living FAQ’s
Get Help Understanding Your Options
If you would like more information on your Medicare options, give us a call. We’re more than happy to answer any questions you have about your Medicare benefits & eligibility. We can provide you with plan comparisons in your area that include benefits for supplemental home healthcare. You can also use our rate comparison form to see rates now.