According to Kathryn Coleman, Director at the Centers for Medicare and Medicaid (CMS), a final rule issued in April 2018 has redefined the “primarily health related” supplement benefit definition. As a result, CMS expects Medicare Advantage plan sponsors to begin offering services for enrollees needing assistance with Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL). Plans are not required to provide any of the services and restrictions may apply, but it is a first step toward utilization of Medicare insurance for long-term services. That’s great news for caregivers of Medicare beneficiaries on limited incomes who did not make provision for non-medical care as they age. The list below details possible options resulting from CMS’s new ruling. This list is not exhaustive.

  • In-home support for individuals with disabilities and/or medical conditions needing help with ADLs and IADLs
  • Respite care for caregivers from a personal care attendant or short-term institutional care
  • Stand-alone memory fitness benefit
  • Non-Medicare-covered home and bathroom safety devices and modifications to prevent injuries
  • Transportation to/from doctor visits, the pharmacy or physical therapy with a health aide
  • Over-the-counter items not covered by Medicare or prescription drug plans

Whether Medicare Advantage plans implement any of these services in 2019, or beyond, there will be a growing interest and high demand for long-term services and support as Medicare enrollees age.

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