Medicare Advantage—the private plans that cover one-third of Medicare beneficiaries—has new flexibility to offer more supplemental benefits. Importantly, among those benefits are services and supports for family caregivers.
That’s good news and, in fact, some plans are adopting such benefits. A recent AARP Public Policy Institute analysis of the 2019 Medicare Advantage Landscape Source Files found that 13 percent of the plans are offering family caregiver supports such as respite care, counseling, and skills training – and family caregiver supports are the second most common new category of supplemental benefit being offered this year.
While this may seem impressive at first glance, a closer look shows that most of the plans offering family caregiver benefits are operated by only one major Medicare Advantage insurer, or through some Medicare-Medicaid plans. Although family caregiver supports are not yet commonplace in Medicare Advantage, we hope more insurers will jump on the bandwagon and recognize the importance of this emerging innovation in health care.
Why Family Caregiver Supports Make Sense
Engaging and supporting family caregivers is beneficial for Medicare beneficiaries with complex care needs. Providing them with supportive services can maintain or improve the enrollee’s health, enhance quality of care and quality of life, and even reduce costs.
Family caregivers are involved in a wide range of care processes. They commonly attend older adults’ medical visits, facilitate the hospital discharge process, interact with providers post-hospital discharge, perform complex care tasks (e.g., wound care and tube feedings) in the home, and coordinate and deliver other long-term services and supports.
In short, family caregivers are the largest providers of care. They often make it possible for members of managed care plans to live at home rather than in nursing homes. Not all family caregivers need supportive services, but some do. Plans can offer relatively low-cost services to help prevent caregiver burnout, thereby potentially delaying or preventing costly nursing home placement.
New Opportunity for Family Caregiver Supports
As Medicare Advantage plans consider their benefits packages for next year, they can learn from emerging innovations of progressive Medicaid managed care plans already supporting family caregivers. Meanwhile, over the past three years, we have engaged with insurers, federal and state policymakers, researchers, and advocates to examine this issue. Based on our many meetings as well as phone calls nearly every month, here are our family caregiving-related recommendations for Medicare Advantage plans:
- To help maintain or improve their members’ health, plans should offer appropriate services to address the unmet needs of family caregivers. Plans should offer services that impact care, which can include: assessments of family caregivers’ own needs and preferences; plan representatives’ direct contact with the family caregiver; supportive services, such as training, support groups, family meetings, counseling, and respite care, that are identified in the assessment process to target caregiver supports more effectively; assistive technologies; transportation; and other supportive services.
- Plans should have materials that clearly state who and what is covered. A plan’s family caregiver support benefits may not be available to all enrollees. Plans are allowed to limit the benefits to enrollees with certain health conditions. Also, supplemental benefits can change from year to year. Consumer education and transparency, therefore, are a must.
- Plans should recognize and involve family caregivers, especially when the member depends on them for care. Particularly for plans that serve people who have both Medicare and Medicaid coverage, family caregivers should be part of the care planning process upon consent of the older adult and agreement from the family caregiver. Care coordinators and family caregivers should have each other’s contact information.
- Plans should seek family caregivers’ feedback and involvement to help ensure a better experience of care. We have found that many plans recognize that family caregivers are critical to ensuring the health and well-being of their members and the value that they bring through direct engagement. All plans should adopt such a philosophy.
Fluid Situation Means Opportunity
Still new, Medicare supplemental benefits, and those related to family caregivers in particular, is a rapidly evolving issue. Insurers will likely offer even more Medicare Advantage supplemental benefits in 2020, when the Bipartisan Budget Act of 2018 is implemented. While family caregiver supports are currently uncommon in Medicare Advantage, plans have a new opportunity to provide person- and family-centered services that can lead to better health for older adults and their families.
Wendy Fox-Grage has provided policy research, analysis, and guidance for the AARP Public Policy Institute since 2004. Her areas of focus are long-term services and supports, Medicaid managed long-term services and supports, and home- and community-based services.
Lynn Friss Feinberg is a senior strategic policy advisor for the AARP Public Policy Institute. She has conducted policy analysis and applied research on family caregiving and long-term services and supports for more than 30 years.
Susan Reinhard, RN, Ph.D., FAAN, is a senior vice president at AARP, directing its Public Policy Institute, the focal point for AARP’s public policy research and analysis. She also serves as the chief strategist for the Center to Champion Nursing in America, a resource center to ensure the nation has the nurses it needs.