On April 2, 2018, the Centers for Medicare and Medicaid announced changes to Medicare that will affect coverage for beneficiaries. These changes, expected to take effect in 2019, will impact in-home care and coverage options for the approximately one-third of Medicare beneficiaries enrolled in Medicare Advantage (Medicare Part C) plans.

It’s estimated that the new rule will lead to considerable cost savings! For consumers, these savings will translate to lower premiums or more plan choices and flexibility. The changes reflect growing recognition that non-medical support services play a critical role in minimizing hospitalizations and visits to a healthcare provider.

The following changes will have an impact on in-home care services — here’s what you need to know about coverage and the opportunity to have greater flexibility in making your care decision.

Increased Benefit Payments for Non-Medical Homecare

According to CMS, Medicare Advantage plans will get a 3.4% increase in 2019, considerably more than the 1.84% increase that had initially been proposed. Policyholders will have additional supplemental benefits that they can use to pay for assistive devices and personal care services.

This means that patients will have access to non-medical homecare services, such as assistance with activities of daily living, medication reminders, and meal-preparation, all of which can help seniors better manage their health as they begin to need more support.

Expanded Definition of “Primarily Health-Related”

For the first time, CMS has expanded coverage to include “daily maintenance” services. Supplemental benefits will be allowed if they lessen the impact of health conditions or injuries or prevent them altogether, compensate for physical impairments, and (or) minimize avoidable emergency room visits and other healthcare utilization.

For patients who have difficulty with balance, for example, homecare aides can prevent falls and assist them in using mobility devices. Since MA plans offer more flexibility than fee-for-service plans, most do not require that patients be homebound in order to receive non-medical in-home support services. The new rule will allow more patients to receive in-home care, possibly preventing them from becoming homebound or helping them stabilize their health as long as possible.

Additionally, those who might otherwise be sent to a skilled nursing or rehabilitation facility can receive services at home, since they can supplement in-home nursing services with non-medical support, reducing costs and allowing patients to continue their recovery in familiar environs.

Additional Homecare Options and Better Service Coordination

The Medicare update complements the Bipartisan Budget Act of 2018, which allows MA to offer a greater variety of plans in 2020. A likely consequence will be that private-pay in-home care companies will partner with insurers so that their services can be covered by Medicare, permitting patients to use supplemental benefits for these services rather than paying out-of-pocket.

The 2019 rule will also improve access to services, while mitigating costs, for those who are eligible for both Medicare and Medicaid. Much of this population has complex healthcare needs, so relaxing the homecare eligibility requirements will make it easier for this group to manage their health conditions at a lower cost.

Healthcare providers are also expected to collaborate with payers to add homecare services to policies. Working together, medical and non-medical care providers will be better able to coordinate services, reducing costs and improving outcomes for seniors. Insurers may also expand homecare services coverage in an effort to accommodate consumer preferences and thereby increase the number of enrollees — meaning more choice and flexibility in getting the customized care plan you need.

Because these changes have yet to take effect, their implications aren’t fully understood. However, homecare providers and payers alike are optimistic about the new rule — as should be those who are seeking care..

It is expected to encourage patient engagement, as people who need help will likely have access to more coverage options and support services that, though non-medical, can help them maintain better health and well-being. Some providers are even calling the changes to Medicare a “precursor” to making high-quality in-home services available to all Medicare beneficiaries.

If you or a loved one is looking to learn more about the services that non-medical in-home care can provide, don’t hesitate to reach out. We would love to help answer any and all questions you might have!