Medicare Advantage coverage for groceries?

Apr 6, 2018

  1. Northeast Agent
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    Medicare Advantage coverage for groceries? | BenefitsPRO

    Air conditioners for people with asthma, healthy groceries, rides to medical appointmentsand home-delivered meals may be among the new benefits added to Medicare Advantagecoverage when new federal rules take effect next year.

    On Monday, the Centers for Medicare & Medicaid Services (CMS) expanded how it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare offers.

    Although insurers are still in the early stages of designing their 2019 policies, some companies have ideas about what they might include. Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

    But patient advocates including David Lipschutz. senior policy attorney at the Center for Medicare Advocacy, are concerned about those who may be left behind. “It’s great for the people in Medicare Advantage plans, but what about the majority of the people who are in traditional Medicare?” he asked. “As we tip the scales more in favor of Medicare Advantage, it’s to the detriment of people in traditional Medicare.”
     
  2. sman
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    sman Guru

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    I saw that this morning. It's going to get very interesting this AEP seeing who provides the most additional benefits. I have several clients who swear by the $10 OTC benefit from Humana. Now we get to add groceries to the list. This is going to be fun!
     
    sman, Apr 6, 2018
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  3. gregj
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    gregj Super Genius

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    many, many MANY elements that deteriorate health - particularly the health of people whose health is prone to be compromised - are not "health" conditions at all.

    Clip toenails of Medicare-eligible diabetics - toenails they'd clip themselves if they were able, but sometimes aren't able to - & their feet stay in better shape, meaning, ultimately, that some of them won't need MUCH more costly rescue care down the line.

    Same applies for a LOT of little situations - just clear up clutter in their homes & some of them won't fall over stuff & need ambulances to convey them to hospitals to heal their cracked-open noggins. Etc, etc, etc

    Is there room for abuse? Aw hell yeah, plenty. It COULD all wind up like the home health/DME abuse scandals of 20-30 years ago. But there are ways to curtail those abuses.

    Oversimplifying, but actuaries & underwriters tend to view any & all claims as "losses" - expenses, to be reduced or ideally eliminated. They rarely - if ever - treat initiatives like these as "investments" in member health, that can have measurable positive returns in the form of fewer rescue care events.

    It's intuitively obvious that covering these types of expenditures MAY produce better overall health spending and health care results. Arguably, even if total spending only stays the same, overall quality of health/quality of life improvements are worth the benefit redesign "experiment", The devil is always in the details.
     
    gregj, Apr 6, 2018
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  4. somarco
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    somarco GA Medicare Expert

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    From KHN
    Medicare Advantage Plans Cleared To Go Beyond Medical Coverage — Even Groceries

    Even though a physician’s order or prescription is not necessary, the new benefits must be “medically appropriate” and recommended by a licensed health care provider, according to the new rules.

    Many beneficiaries have been attracted to Medicare Advantage because of its extra benefits and the limit on out-of-pocket expenses. However, CMS also cautioned that new supplemental benefits should not be items provided as an inducement to enroll.

    Can't imagine ANYONE saying buy my plan because you can get ORGANIC groceries. Does the competitor do that?

    Pair with Amazon / Whole Foods delivery and you have a winner.

    All this sounds good but comes at a price.

    How much extra does it cost to have these items covered by insurance?

    How about claims? Who files? What is the admin cost for filing claims? What about claim denials and appeals?

    There are quite a few pharmacy's that won't file insulin under Part B. Why would this be different?

    The devil is in the details.
     
    somarco, Apr 6, 2018
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  5. myinsurebiz
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    myinsurebiz Guru

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    I'll write MA's if they start giving away food . . .

    Snacks in the hood to diabetics? They'll switch plans every week now.
     
  6. Chazm
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    Chazm Guru

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    Rides to medical appts and home delivered meals? Welcome to 2012. We’ve had those for years here
     
    Chazm, Apr 7, 2018
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  7. rousemark
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    rousemark Still Here!

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    Offered through MA plans?
     
  8. gregj
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    gregj Super Genius

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    there've been variations, in demonstration projects, SNPs etc, but explicit provision for reimbursement on a more general basis is, I believe, the "new" thing
     
    gregj, Apr 7, 2018
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  9. myinsurebiz
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    myinsurebiz Guru

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    Gotta love a dude that loves his commas . . .
     
  10. gregj
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    gregj Super Genius

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    to know, know, know me, is to love, love, love me
     
    gregj, Apr 7, 2018
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