Anthem Adds Home Care Benefits Under Relaxed Medicare Advantage Rule

Home care providers have been wondering how insurers will capitalize on the allowance of non-skilled in-home care services under the Medicare Advantage (MA) program since policymakers initially opened that door in early spring. They’re now starting to get some clarity, thanks to Anthem, Inc. (NYSE: ANTM), one of the top players in the MA market.

Indianapolis-based Anthem announced Monday that it’s expanding 2019 MA offerings across many of its affiliated health plans through a new benefits package focused on nutrition, transportation, social isolation and home safety. The new package, which includes a benefit for a personal home helper for eligible members, is part of the insurer’s strategy to leverage innovative supplemental services to help drive better outcomes, Chris Boles, regional vice president of Medicare at Anthem, told Home Health Care News.

“In rolling out this program, what we’re attempting to do here is address some of those social needs and social determinants of health that really supplement medical care and help drive better outcomes — and better overall wellness of our members,” said Boles, who is responsible for Medicare programs in the Indiana, Missouri and Wisconsin markets. “We’re committed to developing innovative products and services.”


The new benefits package is mainly built around six services and generally branded as either “Essential Extras” or “Everyday Extras,” depending on the affiliated health plan. Services include food delivery, transportation, assistive devices, alternative medicine, adult day center visits and personal home helpers.

About 3% of Medicare Advantage enrollees are in plans offered by Anthem affiliates, according to a 2017 Kaiser Family Foundation report. That is a slightly bigger share than WellCare and Cigna plans, but less than those offered by UnitedHealthcare and Humana.

The Centers for Medicare & Medicaid Services in April stated its intent to allow non-skilled in-home care services as a supplemental benefits for MA plans in 2019, as long as the benefits somehow compensate for physical impairments, diminish the impact of health conditions, reduce avoidable emergency room trips or meet similar criteria.


“This is was enabled by CMS relaxing some of the rules this year around what they would allow health plans to make available along with the traditional [Medicare parts] A-, B- and D-covered benefits,” Boles said. “This is something we’ve been lobbying CMS to focus on and allow for quite some time, along with the industry as whole.”

Breaking down the benefits

Specifically, the new package for certain Anthem health plans includes a food delivery benefit, capped at 64 deliveries per calendar year, as well as a transportation benefit of up to 60 one-way trips per year to health-related or other necessary appointments. The package also includes an alternative medicine benefit, giving members access to two dozen acupuncture or therapeutic massage visits each year.

Likely the most exciting news to home care providers, however, is the inclusion of a benefit for up to 124 hours annually of an in-home health aide for respite care, home-based chores and assistance with activities of daily living. Personal home helper services must be provided by a licensed care provider, according to Boles.

“From a growth and attracting new members standpoint, having something like this that is unique and better than what our competitors offer certainly is helpful,” he said. “But it goes beyond that and gets into our commitment to developing products that really do help address the health and wellness of our members. If we don’t do that, there’s no reason for members to sign up with us and no reason for them to stay.”

The new package with select Anthem-affiliated health plans also provides coverage for up to one visit per week for adult day center services and up to $500 for safety devices, such as shower stools, reaching devices and temporary wheelchair ramps.

Individuals enrolled in corresponding 2019 Medicare Advantage plans can select one of the six aforementioned benefits offered, though some require a medical need to utilize. Per member per year, each benefit is projected to cost roughly the same for Anthem, Boles said.

“This is brand new,” Boles said. “Actuaries are pretty smart people, and they can come up with reasonable estimates of what the benefits will be [to Anthem], but time will tell how much we do get out of it. We’ll have some things on here the people maybe don’t gravitate toward.”

Those who sign up for an Everyday Essentials or Everyday Extras package will have the option to switch their selected benefit if, for example, they later determine they need a home helper more than adult day center services.

Anthem may also decide to swap out some benefits in favor of others in the future.

In general, the Medicare Advantage programs allocates federal dollars to private insurers to offer MA plans covering standard Medicare benefits, plus a number of extras, such as vision or dental.

A new frontier

Anthem is one of the first insurers to detail exactly how it plans venture forth in the new Medicare Advantage frontier that CMS created. That’s partly because CMS announced the MA changes “fairly late” in the annual benefit filing cycle, according to Boles.

“Apparently, other carriers did not have as much of an interest or a level of organization to go after this,” he said. “But we were very much focused on trying to add these types of benefits in and pull out all the stops.”

Essential Extras will be available in 2019 through Anthem Blue Cross Blue Shield plans in George, Indiana, Kentucky, Missouri, Ohio, Virginia and Wisconsin, according to the company.

Everyday Extras will be available next year through Amerigroup plans in Tennessee, Texas and New Jersey. Everyday Extras in New Jersey will have neither the transportation nor adult day center options.

Members of Anthem’s affiliated plans in California and Arizona will also have access to a similar package.

Some Anthem health plans already offer a benefit available in the new package. In those cases, individuals will be able to stack the two benefits together.

Medicare’s annual enrollment period begins Oct. 15 and continues through Dec. 7.

“What we’re looking at is, ‘How do we create a bundle of benefits that will be more appealing to each and every one of our members within the parameters of what we can afford to offer in our reimbursement?’” Bole said. “I expect it to be rapidly evolving over the course of the next four or five years as more and more carriers start to think about doing things like this and as we gain experience with how beneficiaries are accessing these benefits.”

Written by Robert Holly

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