CMS to Allow Non-Skilled Home Care Benefit in Medicare Advantage

Non-skilled in-home care supports will be included as a supplemental benefit in Medicare Advantage plans in 2019, according to the Centers for Medicare & Medicaid Service (CMS), which announced the policy change Thursday afternoon.

The move marks the first time that CMS has allowed an item or service to be eligible as a supplemental benefit that covers daily maintenance. Along with non-skilled in-home care supports, CMS will also include portable wheelchair ramps and other assistive devices and modifications when patients need them, according to an announcement Thursday.

“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” CMS Administrator Seema Verma said in a statement. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”


The new policy enables supplemental benefits if they “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization,” the announcement reads.

Medicare Advantage plans have become more popular over the last few years, and enrollment continues to grow. One in three people with Medicare, or roughly 19 million beneficiaries, were enrolled in a Medicare Advantage plan in 2017 according to the Kaiser Family Foundation. The number of Medicare Advantage plans—which cover all Medicare services and are offered through other insurance providers—increased from 2,700 to more than 3,100, according to CMS.

“The proposed updates will result in a payment increase that promotes stability and [ensures] that resources will be available to support beneficiaries enrolled in private Medicare plans,” CMS stated.


The announcement does not explicitly include plans to include hospice benefits as supplemental benefits in Medicare Advantage plans in 2019, though the idea was floated late last year. However, the inclusion of new benefits could signify more changes are to come as Medicare Advantage enrollment continues to boom and providers make plays to become involved.

The addition comes at a time when the skilled home health care industry is making major strides within Medicare Advantage, with players such as Amedisys (Nasdaq: AMED) and LHC Group (Nasdaq: LHCG) take on more exposure in these plans.

Written by Amy Baxter

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