Medicare Advantage

Medicare Advantage

Home health care is changing frequently due to the use of Medicare in payment of services. It is not just the traditional Medicare, rather the new one often referred to as Medicare Advantage (MA). MA is being incorporated into care offered to chronically ill clients.  In addition, Medicare is set to offer supplemental services that are not health-related.


Supplemental services include the determination of social health determinants and assessing them.  One may receive the best health care, but without adequate care in the home environment it is not effective. Patient’s needs are changing significantly from day, hence the need to get new policy and practices in the care provided. Centers for Medicare and Medicaid (CMS) released a proposal to cater for functions that can improve health in the society especially patients with chronic illnesses. According to the Centre for Disease Control and Prevention (CDC), 90% of most annual health bill allocations goes to chronic illnesses. From the statistics, there is a need to focus on quality care and management of chronic conditions.


Yearly Criteria

Supplemental care services are set to be offered by Medicare to improve the health of chronic patients by meeting social needs that are unmet. To receive the funding or non-health care services, one needs to meet a certain criteria as stipulated by the current guidelines. The year 2019 updates focuses more on health benefits such as safety at home, modifications to ensure safety, support given by caregivers and offering adult day care services to clients. Non-clinical needs that are present are the following: helping clients with self-care, especially those who live alone and helping their primary caregivers offer care.


The year 2020 is set to bring new and more innovations. An example of new ideas is the Special Supplemental Benefits for the Chronically Ill (SSBCI) whose main role is to ensure the client is catered for not just health wise, but also in their social needs. An example of services that are catered for include non-medical supply, transportation and delivering meals at home among others.  Meal delivery keeps their nutrition in check and ensures neglected clients are well-cared.


SSBCI is a pathway to open up more policies, and dedication to increase the therapy offered at different homes. Eligibility for the SSBCI program is that one requires extensive care and frequent coordination, the health outcomes of the condition are adverse, be at risk of frequent hospitalization and has a life threatening or complex chronic illness. Medicare managed manual gives examples of chronic illnesses such as cancer, metabolic issues, and mental disease among other conditions. Chronic conditions cannot be cured, all they need is management.


New Medicare

Traditional Medicare does not allow the care givers such as nurses to have their services billed to them. The new medical advantage (MA) which is also known as the developed Medicaid, allows such health care providers to be covered under the insurance. Palliative care is offered in the comfort of a client’s home. Most time palliative care is offered at elderly, which may not offer a suitable environment for clients. Some aged persons prefer palliative care near their loved ones.  MA increases comfort since Medicare only pays for clients who cannot leave their homes while the rest who can move around need to seek help in a palliative home. MA caters for a client’s wishes and needs.


For client follow-up, nurses are sent to the client’s home either weekly or monthly depending on the care they are offering. The main role is to follow-up the clients’ medication, food intake, cases of neglect and overall progress. MA ability to pay for such services improves the prognosis of clients. Medications may be present, but the intake is not progressive as compared to the prescription given. Clients are well-cared for despite their health status. Without follow-up conditions such as diabetes and hypertension end up with complications that are deadly. Frequent hospitalizations and regular visits to the emergency room are reduced by the regular follow-up.


Quality care offered in the home is set to grow and develop. Money is constantly saved since trips to the emergency room and hospitalizations are reduced. This is a type of health care that empowers not just the client but also the family as a whole. Health care knowledge about basic factors such as hygiene and the importance of hand washing goes a long way in keeping the family healthy. Primary prevention is practised and implemented in the basic unit which is a home. It overflows to the society as a whole making it healthy.


Health care spending in the USA amounts to 18% of the country’s economy. Despite having such a large percentage, it is characterised by inequity, low quality services and inefficiency. It creates frustrations from the citizens that depend on the care given. MA’s are attractive to Baby Boomer’s due to the advantages accompanying the insurance since it can compete with the private insurance which is impossible to pay. The generation is attracted to the services given even in their later lives after employment.


MA integrates health care in one large plan. Traditional Medicare is difficult due to the fragmentation of services. Coordination of care given is paramount in ensuring the success of services offered. MA pushes to keep chronic clients safe and receive the best care offered.



In conclusion, MA is set to redefine health insurance offered by increasing the quality of care offered. Health is not just the absence of disease or infirmity, it is the state of complete social, mental, emotional and physical wellness (WHO). Chronically ill clients in the past needed private insurances to enhance the services they would receive from the health care workers.  MA is not only offering a comprehensive package, but also offering a SSBCI. Social determinants of health are checked during every visit that the client receives. By doing so, any cases of neglect or abuse are sorted without any issue. Safety measures are put in place to keep the client safe. Finally, the hospitalization and emergency room visits are significantly reduced for the client.