In Home Care Reimbursement and Medicare Advantage

Medicare Advantage and Caregiving

There’s good news for seniors who enlist the help of caregivers and other in-home health services. Announced in early 2018, changes in Medicare will allow reimbursement for in-home health care. In 2019, the goal of Medicare Advantage (MA) is to cover non-skilled in-home care services as a supplemental benefit.

Under the expanded definition of primarily health related, MA “will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.” [i]

As the Boomer population continues to age, Medicare and Medicaid have had to adapt and make changes to accommodate their needs and offset the cost to support a large part of the population. For years, the focus has slowly shifted from “the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid,” which has opened the door for additional motivation for caregiving services as well. [ii]

As the cost of healthcare continues to rise, insurance companies and patients feel the strain. Insurers are steadily turning the attention on savings by giving senior patients in-home care. Taking away some of the benefit restrictions makes it easier for seniors to receive that care. [iii]

The goal of Medicare Advantage in 2019 is to make it easier for patients to get the care needed for them, rather than a one-size-fits-all plan. A more tailored plan would include in-home care, which would aid in daily activity like bathing, dressing, cooking, or meal delivery. [iv]

What does this mean for seniors?

Including non-skilled in-home care in the 2019 MA plan will be a benefit for seniors. Allowing caregiving services and home care services to fall under the umbrella of health care coverage gives seniors more options for managing their health. If a fall or other health concern occurs, rather than heading straight to the emergency room, seniors can receive help either in-person or over the phone.

In-home care providers have seen a surge in growth in the last several years, and will only continue to grow as the population continues to age. Lifting restrictions on supplemental benefits and giving patients the chance to receive care at home will allow companies like Meetcaregivers more flexibility in assisting with care.

Additionally, by focusing care and wellness outside of the doctor’s office or hospitals, seniors spend their time how they want to, in the care of their own home, and at a much lower rate. Plus, the changes in the MA plan will cover things such as wheelchair ramps, which will vastly improve the quality of life for many patients.

According to Edo Banach, CEO of the National Hospice and Palliative Care Organization, “The cost and the quality of care delivered in the home is generally more efficient and effective than care provided in an institution.” [v] These big changes in MA mean that not only will seniors spend less time in the hospital, but they will also receive the same level of care, if not better, all in the comfort of their own home.

 

[i] https://homehealthcarenews.com/2018/04/cms-officially-adds-non-skilled-in-home-care-as-medicare-advantage-benefit/

[ii] https://homehealthcarenews.com/2018/04/cms-officially-adds-non-skilled-in-home-care-as-medicare-advantage-benefit/

[iii] https://www.modernhealthcare.com/article/20181027/NEWS/181029949

[iv] https://www.modernhealthcare.com/article/20181027/NEWS/181029949

[v] https://www.modernhealthcare.com/article/20181027/NEWS/181029949

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