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What Are Medicare Advantage Plans' New Mini LTC Benefits Really Like?

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A team of actuaries at Milliman says 577 Medicare Advantage plans are now providing at least one benefit that’s similar to the type of benefit a long-term care insurance policy might offer.

The most popular “long-term care type benefit” is for support for caregivers: 421 plans offer caregiver hotlines, respite services or other caregiver support benefits.

The most unusual LTC type benefits are benefits for housekeeping and therapeutic massage. Just one plan offers either of those benefits, the actuaries found.

(Related: 4 Top Medicare Advantage Mini LTC Benefits)

Some of the other LTC type benefits offered by at least a few plans include backup support for medical equipment, access to personal home care, and access to a “wandering support services.” Wandering support services help caregivers with loved ones who have dementia, are unable to go out alone safely, and may try to go out on their own.

The Milliman team found that the counties with the highest level of access to LTC type benefits per Medicare Advantage enrollee are mostly in Arkansas, Montana, Missouri and Texas.

The actuaries have published those findings in a new report based on an analysis of data from the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs the Medicare Advantage program.

The program gives health insurers a chance to provide coverage that serves as an alternative to traditional Medicare program coverage.

Medicare Advantage LTC Type Benefits

Traditionally, Medicaid has covered nursing home care for poor people and other people who qualify for Medicaid nursing home benefits under state and federal eligibility rules.

Medicare has provided some home medical care and skilled nursing facility care for people who were recovering from acute health care problems, but it has declined to provide skilled nursing care for people who are not getting better, and it has not provided support services unrelated to health care.

CMS has let Medicare Advantage issuers slip extra support services into special needs plans, and it has let the Medicare program participate in “soup to nuts” pilot programs for people who qualify for both Medicare and Medicaid.

A year ago, CMS officials said they would let issuers classify some LTC type benefits, such as adult day care services benefits, as being “primarily health related” starting with the 2019 coverage year. Officials said the move to expand the definition of ‘primarily health related” is appropriate, because the supplemental benefits relate to the “social determinants of care” and may help people with health problems recover faster, or avoid the kinds of problems that could force them back into the hospital.

In many cases, the Medicare Advantage plans offering LTC type benefits this year have put tight restrictions on those benefits. Although a plan might offer adult daycare services, for example, the plan might cover only a few days or weeks of adult daycare fees.

2020 Supplemental Benefits

This year, CMS is saying that, in 2020, Medicare Advantage plan issuers can offer “special supplemental benefits for the chronically ill,” or SSBCIs.

The Milliman actuaries say they believe the SSBCIs will be different from the kinds of LTC benefits issuers have started to add in 2019.

Those benefits will be LTC type benefits that are not primarily health related, and those benefits will be available only to patients who are chronically ill and meet strict eligibility criteria, according to the Milliman actuaries.

Issuers will have broad discretion in developing the SSBCIs, the actuaries say.

What This Means for Plans

The actuaries say issuers will have to be careful when they try adding SSBCIs or other LTC type benefits to their 2020 Medicare Advantage plan proposals, because the demand for the benefits could be high, and costs of the benefits could also be high.


A copy of the Milliman report is available here.

Information about the chronic care benefits coming in 2020 is available here.

— Read CMS Posts 2020 Medicare Advantage Mini Short-Term Care Rules, on ThinkAdvisor.

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