Medicare Players Team Up for 2020 Chronic Care Push

Regional health carriers could make “short-term long-term care” Medicare Advantage plan benefits a lot more common in 2020.

The 47 regional carriers in the Health Plan Alliance have joined with two consulting firms to form the Alliance Medicare Advantage Supplemental Benefits Consortia.

(Related: 4 Top Medicare Advantage Mini LTC Benefits)

The new alliance will help the member carriers look into the idea of offering non-medical benefits, such as transportation services and in-home assistance, to Medicare Advantage plan enrollees in 2020.

The alliance will also look into opportunities for offering benefits designed to meet the needs of enrollees with specific chronic conditions, such as diabetes or high blood pressure.

The alliance will help members decide which new types of benefits to offer.

The Players

The consulting firms in the alliance are Faegre Baker Daniels Consulting and Wakely Consulting Group.

Faegre Baker Daniels is an arm of a law firm.

Wakely is an actuarial consulting firm.

The list of carriers includes well-known health insurers and managed care companies, such as AvMed, which has about 370,000 major medical enrollees in Florida, and Geisinger Health Plan, which has about 600,000 major medical enrollees in Pennsylvania.

The carriers in the Health Plan Alliance formed that organization in 1996, to give provider-owned health plans a new, for-profit vehicle for developing and implementing new ideas.

The Health Plan Alliance does not affect community-level competition, because the carriers in that alliance are in non-competing markets, according to the Health Plan Alliance.

The Medicare Advantage Benefits Race

Policymakers in Washington once tried to keep Medicare out of the chronic care and non-medical care markets, in part to give commercial insurers a chance to establish a private market for long-term care insurance (LTCI).

Now, major carriers are showing less interest in offering private LTCI, and, in some cases, saying that they would prefer to participate in public-private LTC benefits hybrid programs.

Earlier this year, managers of the Medicare Advantage program eased obstacles to carriers offering limited amounts of chronic care benefits through that program, by announcing that they would classify benefits related to the “social determinants of care” as benefits that Medicare Advantage plan issuers could offer as supplemental benefits.

The new flexibility gives carriers a chance to add what amount to “short-term care” benefits, or convalescent care benefits, to plan benefits, in an effort to improve enrollee health and hold down overall spending.

The news about the rule change came out too late for many carriers to add major “mini LTC” benefits to their benefits packages. But analysts from Avalere Health looked at Medicare Advantage data files and found that hundreds will offer at least one mini LTC benefit in 2019.

The annual enrollment period for 2019 Medicare Advantage plan coverage started Oct. 15 and is set to end Friday.

For a rundown of the most popular mini LTC benefits, see the data cards in the slideshow above.

In many states, a policy classified as an LTCI policy must provide coverage for at least three years. Under that definition, the new chronic care or non-medical benefits introduced for 2019, or that might emerge in 2020, would not be LTCI benefits. But they could end up looking like samples of LTCI benefits. In some cases, it’s possible that they could increase consumers’ appetite for true LTCI products, by make consumers more aware of the need for LTC services, and of the need for arrangements for paying for LTC services.

— Read Maybe Traditional Medicare Should Cover Chronic Care, Too: Hearing Witnesses, on ThinkAdvisor.

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