Displaying items by tag: Medicaid

Posted in the Senior Care Topics Series by Everbrook Senior Living

Seniors reading or watching the news are informed that Medicare, through its parent agency, Centers for Medicare and Medicaid, CMS, is now covering some essential non-medical services such as in-home care, transportation, and soon phone consultations with the doctor. In brief, Medicare following passage of the CHRONIC Care Act of 2017 and through reinterpretation of its own rules, has empowered only Medicare Advantage Plans, “MA”, to offer a broader array of supplemental benefits including vision/hearing screens to name a few and now non-skilled home-health to beneficiaries who demonstrate a medical need for such services. A supplemental benefit under Medicare is defined as: 

• A service or benefit not covered by traditional Medicare 
• A service or benefit that is primarily health-related, and
• A service or benefit in which the MA plan incurs a non-zero direct-medical cost.

Although seen universally as a positive step toward the continuing trend to reform coverage rules so medical providers can be paid to treat longer term chronic illness, in reality, seniors in need of home-health aides to support disabilities or who hope to talk to their doctor over the phone instead of having to travel their office will likely have to wait several years to receive those benefits in manners which make real improvements to their quality of health and life. Yet, for seniors with complex chronic illness which includes many senior living residents, MA plans appear to be the best option to get the most comprehensive coverage including essential supplemental benefits not available in traditional Medicare like in-home care or telehealth benefits, although with some uncertainties to work through. Medicare Part D amendments and other payment models being tried at CMS are not discussed here.