Paying for Nonmedical Needs
THE CHALLENGE
Aging well means many needs are met, not just medical needs. As we get older, the majority of us will need some nonmedical help to remain independent. It might be picking up groceries and/or preparing meals, getting to social affairs, bringing helpers into our homes, and the list goes on.
Medicare beneficiaries with multiple chronic conditions and nonmedical needs spend the majority of Medicare dollars. Families struggle to care for older loved ones with these challenges, which can be physically and emotionally draining with substantial out-of-pocket costs.
The financial implications are profound.
As it stands, families cover more than half of long-term care (LTC) costs through out-of-pocket spending, so having a nonmedical need subjects a majority to catastrophic financial risk. Hear from Bernie and Rita.
Working with the National Opinion Research Center, we track public opinion on LTC financing and related issues. Check out the latest.
The Opportunity
We work with knowledgeable partners and policymakers to develop solutions on how to better finance and deliver quality care to older adults with complex care needs. A significant achievement came in 2018 with passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. This federal law allowed health plans and providers to pay for medical and nonmedical care for those in Medicare Advantage plans, and those with dual Medicare and Medicaid coverage.
Aim and Approach
Covering Nonmedical Needs Through Medicare Advantage
For the first time, Medicare Advantage plans have significant flexibility in designing Special Supplemental Benefits for the Chronically Ill (SSBCI) that meet the individual needs of enrollees. While the SSBCI are a relatively small part of the Medicare Advantage program, they represent a turning point. Medicare can now pay for nonmedical services, such as adding grab bars to bathrooms, installing wheelchair ramps in homes, and more. In addition, people with limited transportation can use telehealth options to talk to clinicians by phone or over the computer.
Learn more about Medicare-Medicaid flexibilities and particular use cases since the pandemic.
Our Thought Partners
To achieve long-term adoption of SSBCI in a manner that improves health care for the chronically ill, Medicare Advantage payers and providers needed new principles to guide the implementation. ATI Advisory (ATI) and the Long-Term Quality Alliance (LTQA) convened and led a working group comprised of national experts on Medicare Advantage and long-term care to develop Guiding Principles for New Flexibility Under SSCBI.
These principles illustrate how Medicare can create the flexibility to meet people’s needs while still balanced with appropriate guardrails to protect beneficiaries, providers, Medicare Advantage plans, and the integrity of the Medicare program overall. The principles reflect a shared vision to guide diverse stakeholders as they develop, implement, and offer SSBCI. ATI and LTQA also produce data insights that track and benchmark nonmedical benefit trends.
Other Approaches to Financing Nonmedical Needs
There are other approaches to supporting people’s nonmedical needs outside of health care. Partners have worked in this space to identify and demonstrate methods, such as making long-term care insurance (LTCI) a more affordable, flexible option for families.
Our Thought Partners
The Bipartisan Policy Center (BPC) develops workable policy solutions focused on how to finance and deliver quality care to people with complex care needs. Their latest report draws on recommendations and provides a roadmap of federal policy solutions that Congress and federal agencies should consider to improve the financing and delivery of person-centered care for individuals with complex medical and nonmedical needs.
Transforming Care in the Time of COVID-19
In this video, MayBell and Oneda Turner discuss their experiences with Choice in Aging and the Bedford Center. Learn how the adult day health care center adapted during the pandemic to continue supporting older adults and their family caregivers within community.
Spotlight on People's Experiences
This video was shown during our 2021 Forum: Amplifying All Voices in Aging, and part of our effort to highlight people’s experiences aging and engaging with the health care and long-term services and supports systems.
Formative Reports
Urban Institute
Microsimulation Analysis of Financing Options for LTSS
Older adults face a significant risk of developing chronic health problems and becoming unable to perform basic tasks on their own. In 2011, 7.7 million adults ages 65 and older received help…
Milliman, Inc.
Premium Estimates for Policy Options to Finance LTSS
This resource focuses on premiums expressed in 2015 dollars for individuals purchasing LTCI coverage and draws comparisons to premiums for policies commonly sold in the private market…
Health Affairs
Financing LTSS: Options Reflect Tradeoffs for Older Americans and Federal Spending
Under current policy, people needing long-term services and supports (LTSS) will cover roughly half…
Infographics
Half of adults in the United States age 65 and older will need high levels of help with daily activities.
One in seven of all older adults will need help with everyday activities for five or more years.
Get informed.
This ATI white board video describes the need for new LTC financing solutions and encourages all Americans to join the conversation.
Also, The Case for Financing Older America’s Long-Term Care Need resource is available for download and wide use.