Medicare Advantage is About to Change. Here’s What You Should Know.

For decades, family members and doctors of individuals on medicare have lamented the narrow coverage the non-medicinal aspect of preventable issues, such as grab bars in showers for the elderly woman that may slip or an air conditioner for the aging gentleman with asthma. Medicare would easily pay for the expensive emergency room trips, services, and medications, but would not have assisted with the less costly preventative measures.

This appears to be changing. Those enrolled in Medicare Advantage will have their “supplemental benefits” definition reinterpreted according to Medicare officials. Private insurers that underwrite Advantage plans will have the ability to tack on a longer list services if they are deemed in any way health-related, such as: “Adult day care programs. Home aides to help with activities of daily living, like bathing and dressing. Palliative care at home for some patients. Home safety devices and modifications like grab bars and wheelchair ramps. Transportation to medical appointments. “

“What I find most fundamental is the recognition, . . . that this bright line between ‘medically necessary’ and things necessary to maintain health — like proper nutrition and transportation to a doctor’s office — is an illusion,” says Dr. Diane Meier, a geriatrician who directs the Center to Advance Palliative Care at the Icahn School of Medicine at Mount Sinai in New York.

See Paul Span, Medicare Advantage is About to Change. Here’s What You Should Know, New York Times, July 20, 2018.

Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.