The recent budget deal in Congress included some changes in Medicare that haven’t received enough attention.
The two-year budget deal in early February included a bill called the Creating High-Quality Results and
Outcomes Necessary to Improve Chronic Care Act, also known as CHRONIC. The bill had passed the
Senate in October and was rolled into the budget bill.
A significant provision allows Medicare Advantage plans to tailor some treatment for people with
chronic conditions, offer specialized care at home and offer other “social supports” as part of their benefits. Those benefits can be tailored to the specific needs of individual beneficiaries. Previously, Medicare Advantage plans had to provide identical benefits to all beneficiaries.
Also, support for telemedicine will be extended and enhanced. Beginning in 2020, Advantage plans may
offer expanded telemedicine benefits and will have more flexibility in using telemedicine.
Another change is the Independence at Home program is expanded. This program allows people with multiple, chronic, complex and expensive conditions to receive some specialized care at home. For example, beneficiaries needing dialysis could have this done at home and conduct their monthly
updates with doctors using telemedicine. The goal is to increase and improve treatment for beneficiaries with chronic conditions by enabling them to receive more of it at home instead of having to go to a medical facility.
Home-delivered meals, rides to the doctor and other social support services also can be part of the benefit package.
Remember, these changes apply only to Medicare Advantage plans, not traditional Medicare. Also, they
aren’t mandated. Plans can choose which benefits to offer and tailor them to individual members. The
benefits won’t be available immediately. Most won’t be available until 2020.
Another provision of the law requires pharmaceutical companies to provide discounts to Medicare Part D beneficiaries who are in the “doughnut hole.” The doughnut hole, or coverage gap, occurs when prescription drug prices rise above a certain level. The beneficiaries must pay all prescription costs
above that level until the total prescription expenses reach the “catastrophic coverage” level in which the plan pays most of the costs. The discount mandate doesn’t take effect until 2019.
Another provision in the budget law eliminated the Independent Payment Advisory Board (IPAB). This panel was empowered to mandate ways to reduce Medicare’s costs.