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NY Elder Law Estate Planning: Medicare to expand in-home health service options for seniors in 2019

Starting in 219, seniors in many states will qualify for additional in-home services such as help with chores and respite for caregivers through private Medicare Advantage insurance plans, an expansion that can help some elders live in their own homes for longer periods of time. Many of the services now covered under the new Medicare Advantage plans are similar to those that seniors would receive in assisted living facilities but help prevent the immediate need for such types of care moving forward.

 

The expansions to Medicare Advantage plans offering these services will begin with 20-states in 2019, with the aim to expand the programs to more as time goes on. Eventually, the goal will be to incorporate some or many of what these programs to traditional Medicare plans, which is still the choice for two-thirds of seniors living in the United States.

 

To qualify, Medicare Advantage members will need a health related reason and while some plans may not have any added costs there will be some price variations for others, depending on the services offered. Some plans may cover up to one day a week at an adult day center while others may only provide for certain types of in-home care services.

 

Across the 20-states offering the new benefits on Medicare Advantage plans starting next year, 12-insurance companies will sell an estimated 160-plans that will benefit approximately 780,000 beneficiaries. The most popular options expected to be exercised include in-home helpers and support for caregivers.

 

While Medicare itself does not pay for the extra benefits, the insurance companies are able to offer the additional services when their bids submitted to CMS fall below Medicare’s rate. Using complex formulas, insurance companies are able to finance the plan additions with these differences. With major insurers like UnitedHealthcare and Humana are participating, the insurance industry is hoping to turn a profit while offering improved care for seniors.

 

Even though these new Medicare Advantage plans will help improve aspects of health care for seniors, there is still no substitution for long term care coverage which unfortunately still remains too expensive for many individuals to obtain. For some seniors and persons with disabilities, Medicaid becomes the only option but in turn requires potential beneficiaries to spend down there assets to meet income and asset levels to qualify for this type of government assistance.

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