CMS to Allow Non-Skilled Home Care Benefit in Medicare Advantage

[Mr_Ed]

I've got a great idea.
I've created a new long-term care insurance policy.
It's amazing.
It'll only pay benefits when there is:

"a reasonable expectation of improving
or maintaining the health or overall
function of the chronically ill enrollee
and may not be limited to being
primarily health related benefits."


Who wants to sign up?
I'll take your application right over the phone.
:-)

 

[GOGO]

If MA will be offering Non-Skilled Home Care, Does the agency have to be a Certified Medicare Provider?

 

[kpbdy99]

This is concerning, but it's not LTC insurance. First, it has to pass financial muster in the long run, and it won't. This would cost billions. The Class Act got shot down eventually, and that was based on expectations of FUTURE costs, not costs of people already at the age where this kind of care is imminent. Next, here's the definition of chronically ill:

“(iii) CHRONICALLY ILL ENROLLEE DEFINED.—In this subparagraph, the term ‘chronically ill enrollee’ means an enrollee in an MA plan that the Secretary determines—

“(I) has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee;

“(II) has a high risk of hospitalization or other adverse health outcomes; and

This is a medical trigger.

That said, we all know that the public is desperate for any excuse NOT to buy long term care insurance. This is going to catch a lot of those peoples' attention, I'm afraid. Ugh.

 

[somarco]

The operative word in this change is "allow". That is different from requires, or mandated.

How many MA carriers will jump on board? Who will be the first to go "all in" for additional "free" benefits?

Prior to Obamacare a few states allowed health insurance to be sold across state lines. To my knowledge, not a single carrier filed to participate in that relaxed rule environment.

My feeling is this is a trial balloon and few, if any carriers will pick up the ball and run with it.

Carry on.

 

[Northeast Agent]

Has anyone seen this added to the 2019 MA plans in their area? The only new thing extra I've seen so far is transportation (which is usally only with the SNPs).

I did go to the "debil's" meeting a couple of weeks ago and they haven't released their Part D rates yet. Maybe they are going toe-to-toe with Silver Script or Envision? They did say, however they will be holding more meetings closer to AEP, so maybe they are holding something back?