July 2020
About a third of those enrolled in Medicare have the private portion of this government-sponsored medical insurance for seniors and some people with disabilities. Called “Medicare Advantage” (or Medicare Part C), the private alternative to traditional Medicare is an increasingly popular choice among the program’s 60 million members.
As of 2020, enrollment in Medicare Advantage sat at just over 24 million people. The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, is expecting even higher enrollment for 2020 – 24.4 million, an increase of nearly 30 percent in the last two years.
There’s a reason why Medicare Advantage (MA) plans are popular. By law, these plans must cover at least the same benefits as Original Medicare, which includes Parts A and B together. Beyond that, most MA plans cover a host of added benefits that make them an attractive and affordable alternative to traditional Medicare. Added benefits typically include prescription drugs, dental, vision, hearing and gym memberships.
These plans also tend to cost next to nothing on top of the premiums you’d pay for Original Medicare. As a tradeoff for better benefits, though, MA plans usually limit networks and provider access, which can be a hassle for people in rural areas or those living in places without many doctors to choose from.
Whether you’re in the Medicare Advantage club already or not, the annual enrollment period gives you a perfect chance to assess your needs to see if an MA plan will work for you.
Lower Premiums for More People
You don’t often hear about premiums going down – unless you’ve been following the path of Medicare Advantage plans over the last decade. MA premiums vary by plan type since they’re sold by individual private companies, but the government tracks premium prices to give people an average so they know what to expect.
Medicare Advantage premiums in 2020 will drop to an average of $23 a month. That’s about 14 percent less than it was last year and nearly 28 percent lower than it was in 2017. Per the CMS, next year’s premium average is the lowest it’s been since 2007.
Of course, averages don’t tell the whole story. You may find plans that are more expensive than that where you live, or you could find plans that cost nothing extra on top of your premiums for Original Medicare (which you still pay even if you have an MA plan).
That’s why it’s important to shop carefully during open enrollment, which runs from October 15th through December 7th. During this enrollment period, you can sign up for a new MA plan, switch MA plans or go from MA back to Original (and add a Part D drug plan). Shopping around might seem like a chore, but it’s a good way to make sure you’re getting the coverage you need for the best deal you can.
Greater Access to MA Plans Nationwide
Not only will premiums be lower for lots of people, but there will be more plan options to choose from throughout the country.
In 2019, individual counties in the U.S. had access to about 33 MA plans. That will jump to about 39 plans next year, representing an increase of 49 percent since 2017. Bottom line? You might have half a dozen new plans to choose from for next year, and the plans that are available could be even more enticing, especially if you’ve got a chronic health condition.
Extra Benefits for People with Chronic Conditions
Starting on January 1, 2020, Medicare Advantage plans can offer unique benefits to people with chronic health conditions. It’s a pretty significant shift in CMS policy, but it’s not the first time that CMS has expanded the definition of approved benefits for Medicare Advantage members.
Before last year, MA plans could only offer supplemental benefits if they met the “primarily health related” standard, meaning they served a non-medical medical purpose, like shower bars for people with disabilities.
In 2019, CMS started allowing MA plans to offer supplemental benefits that were still primarily health related but this time to specific members. They didn’t have to adhere to the “uniformity” provision that meant all enrollees had the same access.
MA plans can take it a step further in 2020 and offer benefits that might not seem, on the surface, to be health-related but that benefit people with chronic health conditions. And by the way, the CMS keeps a list of approved chronic conditions:
- Alcohol and other drug dependences
- Autoimmune disorders (specific ones)
- Cancer, except for pre-cancer conditions and in-situ status
- Cardiovascular disorders (specific ones)
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) that requires dialysis
- Heart failure (chronic)
- Hematologic disorders (limited to certain severe ones)
- HIV/AIDS
- Lung disorders (specific ones)
- Disabling mental health conditions (specific ones)
- Neurological disorders (specific ones)
- Stroke
The agency reassesses the list from time to time, but these are the 15 types of chronic conditions that are eligible for supplemental benefits under MA plans. What are those benefits? Well, that depends.
Now that MA plans have freedom in creating plans that include specific benefits for people with chronic conditions, there’s greater flexibility – which means more variables. Examples of supplemental, non-healthcare-related benefits could include:
- Meal delivery services on a longer-term basis
- Transportation to doctor’s visits, grocery stores or other non-emergency locations
- Air quality improvement services, such as carpet shampooing for people with asthma
- Services designed to address social needs
The guideline from CMS is that each supplemental benefit for people with chronic conditions must “have a reasonable expectation of improving or maintaining the health or overall function of the enrollee as it relates to the chronic condition or illness.” In other words, these benefits have to serve an actual purpose in helping someone maintain or improve quality of life.
Even better, CMS is allowing MA plans to offer benefits for capital improvement – i.e., changes you make to your home to make it more compatible with your condition. These could include widening your hallways or doorways and building permanent access ramps. Individual MA companies can decide the extent to which they’ll cover any supplemental benefits.
The CMS estimates that about 250 plans in 2020 will offer these non-healthcare supplemental benefits and that these plans will serve about 1.2 million people. If you have one of the 15 conditions listed above, make sure to shop around wisely during open enrollment this year (again, October 15th through December 7th). You may find a great deal on coverage that not only addresses your medical needs but your lifestyle needs as well.