In early April, the Centers for Medicare & Medicaid Services (CMS) announced that it will expand what it considers a health-related supplemental benefit. What this means for Medicare Advantage plan holders is that even more services and goods may be covered by their plans, specifically ones that focus on preventative measures. In fact, one analysis found that at least 40 percent of Medicare Advantage plans will offer some form of new supplemental benefits in 2019.

This definition is important to the private companies offering Medicare Advantage (Part C) plans because it specifies what must, what can, and what cannot be covered. Insurers are not required to cover anything not defined as medically necessary, but they now have the ability to.

We expect these changes will vastly expand what can and will be covered by your plan.

What Was Covered Before?

Medicare Advantage plans cover, at a minimum, everything that Original Medicare does as well as additional services. One common inclusion is prescription coverage, combining the benefits of Original Medicare and Part D into a single plan called a Medicare Advantage Prescription Drug Plan (MAPD).

Many plans also include dental and vision coverage, as well as health and wellness management programs. Previously, food delivery services like Meals on Wheels were typically covered in a very limited degree such as for a recent return home after surgery or a chronic condition.

What’s New?

CMS feels the reinterpretation of the definition of health-related supplemental benefits will add services to “increase health and improve quality of life.” While the specifics of what will be in 2019 Medicare Advantage plans are still being drawn, there are a few examples members can expect to see.

One key focus of the expanded plans will be preventative services. One example CMS provided in their press release was coverage for non-skilled in-home supports and similar assistive devices.

Some new benefits that may be covered include transportation to doctor’s appointments, healthier groceries, or small modifications to your home, like grab bars.

Additionally, the new interpretation of health-related supplemental benefits could include coverage for transportation to doctor’s appointments, healthier groceries, in-home aides, or small modifications to a plan holder’s home, like air conditioners or grab bars. Many of the changes will allow for compensation of physical impairments and, ultimately, aims to reduce avoidable injuries and illnesses to reduce emergency room utilization.

Will It Be Covered?

The key designation that ultimately decides whether a service or product is covered is its medical appropriateness. While a prescription or physician’s order is not required, a licensed health care provider needs to recommend the service for it to be covered. For this reason, it’ll be a good idea to work with your primary care physician and your plan before assuming something is covered under this new definition.

CMS has cautioned companies against trying to add benefits that act as an enrollment incentive for their plan. Despite this, some detractors of this reinterpretation worry about its implications for Original Medicare. As reported by Kaiser Health News, David Lipschutz, senior policy attorney at the Center for Medicare Advocacy, is concerned that these new benefits aren’t available in Original Medicare.

“It’s great for the people in Medicare Advantage plans, but what about the majority of the people who are in traditional Medicare? As we tip the scales more in favor of Medicare Advantage, it’s to the detriment of people in traditional Medicare.” — David Lipschutz, senior policy attorney, Center for Medicare Advocacy

Benefit packages for 2019 must be first approved by CMS ahead of Medicare’s Annual Enrollment Period (AEP). There will be further guidance on these initiatives over the next few months in the build up to AEP. We’ll be sure to update you as we see the expanded definition impact Medicare Advantage plan benefits.