20 Jan New Medicare Changes: In-Home Support Services a Win-Win
“Medicare policy has not kept up with the times.” This, according to Oregon Senator Ron Wyden, one of the authors of bipartisan legislation advocating expanded services through Medicare Advantage. California seniors who qualify will be able to get additional services such as help with chores, safety devices and respite for caregivers through private “Medicare Advantage” insurance plans.
Patients remain in their homes; costs are reduced
The change reflects the realization that simple home aid will not only impact patients’ wellbeing but will reduce costs for taxpayers. A couple of hundred dollars to install grab bars in the shower can prevent a fall that results in a broken hip, which can become a life-changing injury. For seniors who may be too old or frail to sustain hip replacement surgery, this gets complicated very quickly.
IHSS services include, but are not limited to:
- Domestic and related services: Meal preparation, cleaning, laundry and taking out the garbage.
- Personal care services/non–medical care: Bathing, feeding, dressing, grooming and toileting.
- Paramedical tasks: Assistance with medications, injections, bowel and bladder care.
- Protective supervision: Monitoring persons with cognitive or mental impairments to prevent injury.
IHSS is a statewide program administered by each county under the direction of the California Department of Social Services. It provides in-home care services to those over the age of 65 who are disabled or blind or have limited incomes. The program is designed to help these seniors remain safely in their homes.
Stepping up to address the healthcare needs of an aging baby-boomer generation
It begins to break down the wall between long-term care and Medicare–with very few exceptions, has never paid for long-term care.
- There has to be a health-related reason to qualify, and costs will vary among plans. In some plans, there’s no added cost.
- Limits do apply. For example, a plan may cover one day per week at an adult daycare center.
- Nearly 23 million Medicare beneficiaries, or more than 1 in 3, are expected to be covered by a Medicare Advantage plan in 2019.
- The private plans generally offer lower out-of-pocket costs in exchange for limits on choice of doctors and hospitals and other restrictions, such as prior authorization for services. It’s a growing business for insurers.
Insurance providers are following Medicare’s lead
Insurance providers are responding by addressing the many factors that affect the health and wellbeing of beneficiaries. Anthem offers different packages that include alternative treatments, including acupuncture, adult daycare center visits or a personal helper at home.
- According to Medicare, 12 insurers will be offering expanded supplemental benefits in 2019 through 160 plans in 20 states.
- In four other states and Puerto Rico, such benefits may be available to seniors with certain health conditions.
- Medicare estimates that some 780,000 beneficiaries will have access to the new benefits next year.
- In-home helpers and support for caregivers are the most popular.
Seniors should carefully consider if Medicare Advantage is best for them
Many people still need long-term care coverage for at least part of their lives, and it remains prohibitively expensive. Seniors trying to get long-term care through Medicaid, the program for low-income people, must spend down their life savings.
Consumer advocates recommend that seniors carefully weigh whether Medicare Advantage is best for them. If they don’t like it, they can go back to traditional Medicare, but those with preexisting conditions may not be able to buy a “Medigap” policy to help cover out-of-pocket costs. They can also switch to another Medicare Advantage plan.
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