Many Medicare beneficiaries have been disappointed to learn that Medicare does not provide long-term care benefits. Now, some of that disappointment could be ending. Thanks to new rules from CMS, Medicare Advantage plans can now offer some long-term care benefits.
Long-Term Care Costs
Long-term care refers to services associated with the activities of daily living. When people need help dressing, bathing or eating, for example, they need long-term care services.
According to the U.S. Department of Health and Human Services, these services aren’t cheap. One month in an assisted living facility runs an average of $3,628, while one month in a private room in a nursing home costs an average of $7,698. People who receive care at home will have to pay an average of $20.50 per hour if they need a health aide.
These costs can really add up: 70 percent of people turning 65 now will need long-term care at some point, and the average length of care is three years.
Because long-term care is so expensive, many people do not have the ability to pay out of pocket. Traditionally, Medicare has covered skilled nursing care for a limited period, but it has not covered personal care that is considered non-medical.
For this type of coverage, people have had to turn to separate long-term care insurance policies or meet the financial requirements needed to qualify for Medicaid.
Now a new option is changing this.
The New Rules
Earlier this year, CMS announced that Medicare Advantage plans would be given the flexibility needed to offer some long-term care services.
Discussing the new rules, CMS Administrator Seema Verma cited both the increasing popularity of Medicare Advantage, which covered 33 percent of Medicare beneficiaries in 2017, and the innovation of Medicare Advantage providers.
Among other things, the rules will allow Medicare Advantage plans to offer adult day care services, in-home assistance and respite care for caregivers. Coverage for safety devices like stair rails will also be permitted.
What to Expect
According to Think Advisor, approximately 7.5 percent of enrollees will have access to additional long-term care or chronic condition benefits in 2019. Anthem, for example, will offer enrollees in Arizona and California long-term care benefits that include limited in-home assistance, adult day care center services, meal delivery and respire care for caregivers, as well as transportation services to help enrollees get to health care appointments.
These rules are new, but it appears that Medicare Advantage providers are interested in taking advantage of the opportunity to provide more benefits. Medicare insurance agents and beneficiaries should pay close attention to new coverage types.