Medicare Changes 2019

Just 37 days into the new year and already looking ahead to 2019. My, how time flies.

The folks at CMS are working overtime to find ways to shift the financial burden to insurance carriers and Medicare beneficiaries. To wit . . .

CMS is redefining health-related supplemental benefits to include services that increase health and improve quality of life, including coverage of non-skilled in-home supports, portable wheelchair ramps and other assistive devices and modifications when patients need them. – CMS

The items addressed above are not currently covered by original Medicare, and these changes won’t happen until the 2019 Advantage plans are released.

Although the above press release does not specifically mention original Medicare, one would presume these same new benefits will also apply to Medicare beneficiaries.

So why is covering things that are not medically necessary a bad thing?

Premiums will rise for everyone. Covered DME supplies will be folded into the competitive bidding process. What’s wrong with that? Isn’t competitive bidding a good thing?

One would think.

But rather than relying on a free market to set pricing the government decides winners (those who will be picked to participate) and losers. Historically, once an item is covered by insurance, prices increase rather than decrease.

Laser surgery to correct vision impairment is not covered in most cases. Over time the cost of laser surgery has come down while the quality has increased.

Contrast that with the price of prescription medications.

When commercial insurance plans introduced drug copay’s drugs became MORE expensive, not less. This trend exploded immediately before Medicare Part D was implemented in 2006.

Statista shows drug expenditures rising from $121 billion in 2000 to $205 billion in 2005 and then $253 billion in 2010. By 2017 the annual cost of prescription drugs were $360 billion.

Insulin priced at $17 in 1997 is $138 in 2016.

Back to DME changes for 2019.

All this is not necessarily a bad thing. People who have disabilities that impact mobility would normally be covering home modifications out of pocket. Ramps, hospital beds, slings and other mechanical devices often accompany some medical conditions.

How far will this go?

Handrails, elevators, door modifications to accomodate wheel chairs . . . the list is almost endless.

How much will prices for these items rise over the next few years once they are covered by insurance? Beyond the insurance angle, how much will prices rise for the same items when purchased by those who do not have insurance?

Stay tuned.

#MedicareAdvantage #HomeHealthCare