Insurers have flipped the switch on their marketing machines as the open enrolment period for Medicare approaches, and additional benefits will be key to their success

Insurers will vie for the business of seniors looking for healthcare from October 15

Health insurers are gearing up for the influx of over 65s that arrive every October to ensure their healthcare needs are covered. As companies prepare to convince more seniors a Medicare Advantage plan could be a better fit for them, Peter Littlejohns takes a look at some of the key benefits that could help determine who comes out as the top pick. 

 

The battlefield is set for what’s arguably the most important annual event to most US seniors — Medicare open enrolment.

During this period — which runs between October 15 and December 7 — customers can move from original Medicare to a Medicare Advantage plan, switch from Medicare Advantage to original Medicare, swap one Medicare Advantage plan for another, or choose a different Medicare prescription drug plan.

Making the choice between plans usually comes down to a comparison of the out-of-pocket costs borne by the customer in deductibles, as well as co-pay and co-insurance agreements — two types of cost-sharing between the insurer and insured.

But for those battling to sign-up seniors for a Medicare Advantage plan, the weapon of choice appears to be a veritable smorgasbord of “additional benefits” that can range from an acupuncture allowance to a monthly supply of fresh fruit and vegetables.

 

Encouraging healthier lifestyle choices

Those enrolling for Medicare in 2020 can choose between these additional benefits because of a step change in policy made by the U.S. Centers for Medicare & Medicaid Services (CMS) — the federal agency that controls both programmes.

The introduction of the Bipartisan Budget Act in 2018 lifted a limit on supplementary benefits for policies sold from 2019 onward, which previously only permitted those offering “a primary health benefit” to policyholders.

CMS administrator Seema Verma says: “With Medicare Advantage enrolment at an all-time high, plans need greater flexibility in offering benefits that focus on preventing disease and keeping people healthy.”

medicare advantage benefits
Seema Verma, CMS administrator, believes insurers should focus on preventing disease (Credit: WikiCommons)

A public statement from the department adds: “In 2020, about 500 plans will provide approximately up to 2.6 million Medicare Advantage enrollees with access to expanded primarily health related supplemental benefits — such as adult care services or caregiver support services.”

Insurers have wasted no time in designing and marketing the benefits they hope will help them differentiate from competitors and capture more of the market in 2020.

Some of the perks designed to encourage healthier behaviours in Medicare Advantage policyholders include a monthly delivery of fresh fruit and vegetables, available through Pennsylvania-based Vibra Health Plan, and an air conditioning allowance for Texas policyholders, courtesy of healthcare giant Cigna.

 

AARP Public Policy Institute has mixed feelings about the new benefits

In a recent report on the topic, senior-focused non-profit organisation AARP released its thoughts on the value of supplementary benefits, as well as some of its concerns.

Written by senior strategic policy advisers Jane Sung and Clair Noel-Miller, the report claims that supplementary benefits could have a positive impact on overall health.

They write: “Experts have long recognised that people’s medical conditions and health outcomes can drastically improve with certain types of non-medical support, such as long-term services and supports, family caregiver support services or interventions that address social determinants of health.

“MA plans could cover fall prevention benefits such as ramps or grab bars to reduce the risk of serious injuries often associated with falls. Or, recognising the importance of nutrition on people’s health, MA plans could chose to cover meals as a supplemental benefit.”

On the other hand, the two are cautious that would-be policyholders may misinterpret their entitlement to certain supplemental benefits.

medicare advantage benefits
Some additional benefits on Medicare Advantage policies will only be for those with a chronic health condition

“Second, insurers’ ability to target benefits to certain enrollees could mean that consumers have a harder time figuring out exactly what their MA plan covers — especially if there is a lack of transparency about benefit eligibility,” they add.

“What’s more, consumers also run the risk of choosing a plan based on a supplemental benefit they may not be eligible for if insurers market and advertise new supplemental benefits to all prospective enrollees — while, in reality, they are only available to some.”

A third concern raised by the report is that insurers may market their policies in a way that captures healthier individuals at the expense of those with health issues in order to reduce claims.

The AARP addresses all of these concerns with a recommendation that CMS increase its oversight of non-discrimination requirements and release marketing and advertising guidelines to ensure customers aren’t steered towards policies under false pretences.

 

Supplementary ‘telehealth’ and travel allowances

As part of the Bipartisan Budget Act, the CMS has allowed insurers to provide expanded telehealth services — a practice whereby policyholders can talk to a doctor on the phone for medical advice.

Some providers already offered the service, but by relaxing the rules around policyholder eligibility, more parts of the country will have access, whether in rural or urban areas.

Both UnitedHealthcare and Cigna, two of the country’s largest health insurance companies, have taken advantage of the new rules, which allow Medicare Advantage customers to call, text or video chat with doctors if their medical concern isn’t an emergency.

Several insurers have also taken to including travel perks for customers who might struggle to attend medical appointments.

A third giant in the industry, Anthem, will provide policyholders in Maine with up to 60 one-way trips per year to health-related appointments or other services covered should they enrol in the Essential Extras package.

As the CMS moves the goalposts for what is considered a “primary healthcare concern”, the Medicare Advantage providers winning most business for 2020, could be those who can ferry customers to and from appointments — or even drop-off a monthly box of fruit and veg.