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Medicare Advantage to pay for non-skilled home care

18 Apr Medicare Advantage to pay for non-skilled home care

Last week the Centers for Medicare & Medicaid Services (CMS) issued a call letter finalizing their policy to begin paying for private-duty, non-skilled home care services as a supplemental benefit starting in 2019.

This can be a great benefit for seniors in Westchester, Nassau and Fairfield counties as Medicare has not been a long term solution before.  As it is rolled out, STEPS Home is excited to offer this benefit to our clients in NY & CT, who previously were unable to utilize Medicare for home care expenses.  The only long term public option until now has been Managed Long Term Care through Medicaid, which is a more arduous, expensive, and often generally less attractive option for seniors.  Local Elder Law Attorney, Michael LaMagna of Helwig, Henderson, LaMagna, Gray & Spinola says, "As a reminder, Medicaid is a means tested system, meaning that your income and assets must meet poverty levels to qualify, while Medicare doesn't have income or asset tests."

What is Medicare Advantage?

Medicare Advantage plans are Medicare plans that combine the different parts of Medicare "A" (Hospital Insurance), Medicare "B" (Physician Insurance), and Medicare "D" (Prescription Drug Coverage) into a consolidated benefit.

According to the Medicare website Medicare Advantage differs from Original Medicare in that Medicare Advantage, “…sometimes called ‘Part C’ or ‘MA Plans,’ are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.” Medicare Advantage is also different than a Medicare Supplemental Insurance policy. Some private insurance providers that offer MA Plans in Westchester County, and the White Plains, NY area, include Aetna, UnitedHealthcare, and MVP Health Care.  According to the Kaiser Family Foundation, 1 in 3 people qualified for Medicare were also enrolled in Medicare Advantage, which equates to approximately 19 Million beneficiaries.  The growth of these plans has been staggering.  Enrollment has grown by 71% since the Affordable Care Act (ACA) was enacted in 2010.

What does this mean?

Looking at the details a little closer offers more questions than answers at this point. Previously CMS did not allow supplemental benefits for services whose  primary purpose was “daily maintenance.”  The call letter referenced above addresses expanding the supplemental benefit using the following language, “Under this reinterpretation, CMS would allow supplement benefits if they are used to...compensate for physical impairments…or reduce avoidable emergency and healthcare utilization.”  It also states that, "The proposed updates will result in a payment increase that promotes stability and insures (sic) that resources will be available to support beneficiaries enrolled in private Medicare plans." 

Some of the questions that are being asked are, would we need to pay additionally for home care services if you already have a Medicare Advantage plan? Will the home care benefit be limited to, or exclude, individuals with specific illnesses like cancer or diabetes?  Will the qualification for MA home care services be based on in home needs, such as fall reduction, nutrition, medication management, etc?

Michael LaMagna says, "This will be a new day in Medicare benefits for individuals.  The coverage of non-skilled home health care will permit more individuals to age in place and obtain the services that they need, at home."  Michael can be reached at mlamagna@hhrls.com

The bottom line

  • Non-skilled home care services should covered by Medicare Advantage in 2019
  • There are still several details that need to be ironed out.
  • This initial change opens the possibility for additional services, such as hospice, to be paid for by private Medicare plans.

So, everyone that has a private Medicare plan and who may need home care services now, or in the future, should heave a sigh of relief.  

What Medicare resources are there in White Plains, NY?

  • Senior Benefits Information Centers (SBICs) are a free Westchester County Senior Program that provide Medicare information at 8 public libraries.  Click here for more info.
  • There are also "Medicare Basics" workshops offered several times a year presented by the Westchester County Department of Senior Programs and Services.  Click here for dates.

Feel free to reach out to STEPS Home Care (www.stepshomecare.com) if you have any questions regarding the change, or any other questions regarding how to pay for home care services.  

Helwig, Henderson, LaMagna, Gray & Spinola, LLP is a multi-faceted practice that includes elder care law, guardianships, trusts and estates law.  The have office in Fairfield, Westchester, Nassau Counties and Manhattan.  You can learn more about them at www.hhlslaw.com.  

 

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