Home Care Services Increasingly Covered By Medicare Advantage
The number of Medicare Advantage (MA) plans offering home care services increased for 2023. The in-home support services benefit is now offered by plans in 42 states.
Number of States Offering One Of The Expended Benefits in 2023
- Therapeutic Massage 21
- Adult Day Health Services 2
- Home-Based Palliative Care 16
- In-Home Support Services 42
- Support for Caregivers of Enrollees 21
The Centers for Medicare & Medicaid Services (CMS) started allowing MA plans to offer certain supplemental benefits in 2019. The Medicare program permitted plans to offer different cost-sharing options. These could be targeted for specific populations of beneficiaries.
According to the latest data, the number of MA plans offering at least one supplemental benefit increased from 255 in 2020 to 847 in 2023. Plans offering two of the five options increased from 35 (2020) to 239 in 2023.
Definitions of Home Care Services
Adult Day Health Services that are provided outside the home include such things as assistance with activities of daily living (ADLs), education to support performance of ADLs, physical maintenance/rehabilitation activities, and social work services.
Home-Based Palliative Care are typically services intended to diminish symptoms of terminally ill members with a life expectancy of greater than six months. Services that are generally not covered by Medicare.
In-Home Support Services: Services assist individuals with disabilities and/or medical conditions in performing ADLs and IADLs. These are provided within the home to compensate for physical impairments.
Support for Caregivers of Enrollees can be defined as respite care. This is provided through a personal care attendant or the provision of short-term institutional-based care.
Therapeutic Massage is a medically-approved non-opioid pain treatment alternative.
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services. These can include:
- Part-time or “intermittent” skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide care
- Durable medical equipment
- Medical supplies for use at home
According to the latest Medicare website, a home health care agency will usually coordinate the services following them being ordered by your doctor. The home health agency caring for you must be Medicare-certified.
In-Home Support Services Had Largest Growth
According to the analysis performed by Milliman, a national actuarial firm, in-home support services had the largest growth in plan prevalence among these benefits. This was based on data from 2020 to 2023.
The prevalence of support for caregivers of enrollees almost tripled from 2021 to 2023. They noted that home-based palliative care and therapeutic massage both had small increases from 2022 and 2023.
Important Information For Seniors
The following comes from the Medicare website regarding in-home health care.
“Before you start getting your home health care, the home health agency should tell you how much Medicare will pay.
The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing.
The home health agency should give you a notice called the Advance Beneficiary Notice” (ABN) before giving you services and supplies that Medicare doesn’t cover.
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