The Centers for Medicare & Medicaid Services (CMS) have released the Star Ratings for 2019 Medicare health and drug plans. With the release of the Star Ratings, people with Medicare will have improved access to high-quality health choices for their Medicare coverage in 2019.
“Medicare is committed to empowering seniors to choose high-quality health and drug plans that fit their needs and the needs of their families,” said CMS Administrator Seema Verma. “More high-quality choices mean improved quality care and better customer service at lower cost.”
In 2019, people with Medicare will have more choices and options for their Medicare coverage. Access to the Medicare Advantage program remains strong. The number of Medicare Advantage plans available to individuals to choose from across the country is increasing from about 2,700 to more than 3,100 – and more than 85 percent of people with Medicare will have access to 10 or more Medicare Advantage plans.
Most areas across the country have Medicare Advantage and Part D plans with four or more stars. In 2019, approximately 73 percent of Medicare Advantage enrollees with prescription drug coverage will be in plans with four and five stars. Compared to 2017, approximately 69 percent of these enrollees were in four and five star plans. Approximately 44 percent of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2019.
Medicare Part D prescription drug plan enrollees are also benefiting from improved access to high-quality plans. In 2019, approximately 47 percent of enrollees in stand-alone prescription drug plans will be in plans with four and five stars. Approximately 52 percent of stand-alone prescription drug plans will have a rating of four stars or higher in 2019.

The Star Ratings system helps people with Medicare, their families, and their caregivers compare the quality of health and drug plans being offered. Medicare health and drug plans are given a rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. People with Medicare can compare health coverage choices and the Star Ratings through the online Medicare Plan Finder tool available at Medicare.gov.

Non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans in 2019, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Monday, April 2nd, 2018.

The benefit marks the first time CMS has allowed supplemental benefits that include daily maintenance and custodial care in Medicare Advantage.

“CMS is expanding the definition of ‘primarily health related,” the agency stated in its announcement. “Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

The rule was originally proposed in February and was met with enthusiasm from the home health and private duty home care industries. Home health care providers have already made great strides as partners in MA contracts, and adding non-skilled services opens the door to the growing MA population even further.

“The Medicare Advantage plans have a very different payment environment [than fee-for-service],” Tracy Moorehead, CEO of industry group ElevatingHome, told Home Health Care News at the association’s National Leadership Conference in March. “They have greater flexibilities than the fee-for-service providers do. They don’t have a homebound requriement in many cases. So they are tasked with full capitation, where they have an amount they are provided [with] to care for a patient and they will do whatever they need to make sure that patient doesn’t cost them more money than necessary. And if that [includes] private duty services, then I’m sure a plan is more than ready to pay for that.”

In fact, insurers and payors have been positioning themselves to better align with post-acute care services for years. As the focus also shifts toward the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid, that has provided additional incentive to cover personal care services as well.

Even before this week’s final rule, some providers have been positioning themselves to take on more personal care, with an eye toward MA trends.

“What Humana, UnitedHealthcare, and Aetna have been saying for several years is that we’ve had a great relationship for skilled home health and hospice for quite a while,” said Keith Myers, CEO of LHC Group. “In the last few years, they’re starting to focus more on a dual-eligible population and have needed us to have a bigger commitment in personal services.”