Maybe Traditional Medicare Should Cover Chronic Care, Too: Hearing Witnesses

Photo Gallery: Medicare Advantage hearing witnesses

Medicare Advantage program managers recently announced that they want to let issuers add chronic care benefits to the 2019 benefits packages.

Witnesses who appeared today at a hearing in Washington on the Medicare Advantage program welcomed the idea of adding chronic care benefits to the benefits package, but some suggested that limiting access to those benefits to Medicare Advantage plan enrollees might be unfair to people who stick with the traditional Medicare fee-for-service program.

Karoline Mortensen, a health sector management researcher from the University of Miami business school, was one of the witnesses who raised the idea that adding chronic care benefits to the Medicare Advantage program, but not to the traditional Medicare fee-for-service program, could lead to concerns about fairness.

“Make sure traditional fee-for-service enrollees are not left out,” Mortensen testified.

(Related: Medicare Advantage Plans Can Pay for Many LTC Services in 2019: Feds)

The House Ways & Means health subcommittee organized the hearing. Links to resources related to the hearing, including a recording of the hearing video, are available here.

The 2019 Benefits Package Change

A Medicare Advantage official wrote April 27, in a memo sent to potential 2019 Medicare Advantage plan issuers, that managers will let issuers add a wide range of chronic care benefits as “supplemental benefits,” by changing how they interpret the term “supplemental benefits.”

The Medicare Advantage program lets private insurers offer Medicare enrollees an alternative to traditional Medicare coverage. To make shopping for coverage as simple as possible, and to keep public plan coverage from crowding out private forms of insurance, Medicare Advantage program managers have traditionally kept issuers from including chronic care benefits in their benefits packages.

In recent years, however, many commercial insurers have pulled out of the private long-term care insurance (LTCI) market, and executives from some of the issuers still in the market have suggested at LTCI industry events that the federal government should fill the long-term care (LTC) benefits gap by forming public-private LTC partnerships.

Medicare Advantage program managers have justified the idea of letting chronic care benefits into Medicare Advantage by saying the benefits could address the “social determinants” of health, such as access to appropriate food. Officials have said that a plan issuer could choose to cover adult day care services, home modification services, and almost any other form of chronic care other than nursing home care or home meal delivery.

The Hearing

Mortensen suggested at the hearing that even services that help low-income Medicare Advantage plan enrollees get groceries might be considered an important form of health care improvement service.

“If you don't have food on your table, that could be a significant factor in your health outcomes,” Mortensten said.

Daphne Klausner, a senior markets executive from Independence Blue Cross, a nonprofit Philadelphia-based carrier, said her company would like to find a way to provide a nutrition benefit for recently discharged hospital benefits. She said she would also like to find a way to build dental benefits and hearing aid benefits into her company's benefits.

But Mortensen noted that one challenge for Medicare Advantage managers and observers has been figuring out how to build adjustments for enrollees' socioeconomic status into plan quality ratings.

The socioeconomic status adjustment factors built into the ratings so far have had surprisingly little effect on quality ratings, and that has been a concern for many, Mortensen said.

She said Medicare Advantage program managers need to find good ways to measure the effects of investments in the social determinants of health on people's health.

Andrew Toy, chief technology officer at Clover Health, said benefits for technology could be important to helping to keep people with chronic health problems in their homes.

Clover Health already provides enrollees with chronic health problems a smart speaker than can connect an enrollee with a call center with one push of a button, and it also provides in-home social work with a partnership, Toy said.

Allowing more flexibility for telehealth benefits could also help plan issuers meet Medicare Advantage provider network adequacy standards, especially in rural areas, Toy said.

Also at the hearing, Jack Hoadley, a witness from the Georgetown University Health Policy Institute, said he believes consumers need one-on-one help with understanding and choosing Medicare Advantage plans, not just access to the MedicareAdvantage plan selection website.

The Medicare Plan Finder is a valuable tool, but it “really represents technology of 10 or 15 years ago,” Hoadley said. “It hasn't been modernized and updated.”

One weakness is that a consumer may have a hard time comparing the benefits and out-of-pocket costs for a Medicare Advantage plan with the benefits and out-of-pocket costs for a package of traditional Medicare with Medicare supplement insurance, Hoadley said.

— Read Humana May Lead Aetna, Cigna in Medicare Advantage LTC Race on ThinkAdvisor.

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