Telehealth from home to be added to Medicare Advantage plan’s benefits under new rule

Enrollment in Medicaid Advantage is projected to increase by 11.5 percent, and the number of plans to increase by 600 next year.

Proposed changes issued today by the Centers for Medicare and Medicaid Services would allow Medicare Advantage insurers to be reimbursed for additional telehealth services, a benefit not available through traditional fee-for-service Medicare.

Under the proposed rule, Medicare Advantage enrollees can receive telehealth services from their homes, rather than from a healthcare facility.

MA plans have always been able to offer more telehealth services than are currently payable under original Medicare through supplemental benefits. The Medicare fee-for-service program telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located.

Under the proposed rule, MA plans would have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries, CMS said.

The proposed rule also includes updates for individuals who are eligible for Medicare Advantage special needs plans.

This would be effective in plan year 2020.

Medicare Advantage is a growing, profitable business for insurers. More than a third of all Medicare enrollees choose the private, rather than government insurance and their number is projected to increase by 11.5 percent as a growing demographic of baby boomers ages into retirement.

Medicare premiums are increasing slightly while the average Medicare Advantage premium will decline by 6.1 percent, CMS said. There will be approximately 600 more plans available across the country next year.

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