How Will the Latest Medicare Updates Affect My Loved Ones?

If you’re responsible for someone in long-term care or suffering from a chronic condition, the latest changes to Medicare policy may mean more opportunities for coverage.

For many years, Medicare has denied coverage for therapy costs—and, in some cases, has even terminated treatment—for patients not deemed to be “showing improvement” in their health over time. This has been particularly frustrating for those with chronic degenerative illnesses or disabilities such as Alzheimer’s or Parkinson’s disease—and for caregivers, who often find themselves having to pay out-of-pocket for long-term care. And the costs of that care are only getting higher as rates for many long-term-care services, from assisted living to insurance policies, have been rising (reference our Cost of Senior Care Calculator to calculate your family’s care costs).

Fortunately, recent updates to Medicare law are likely to change this situation for the better. If approved, the proposed settlement of a major class-action lawsuit may ease the rules when it comes to skilled care for those with disabilities or chronic conditions.

What the Settlement Means for Medicare Recipients with Chronic Conditions

“The idea that you would have to show improvement when you have a degenerative disease is blatantly absurd,” said Amy Comstock Rick, chief executive of the Parkinson’s Action Network, in a New York Times article covering the latest changes to Medicare.

As caregivers know, sometimes simply holding steady or slowing the progress of degeneration is a positive treatment outcome. And whether a person’s condition improves or not, skilled care, physical therapy and rehabilitation may be critical in maintaining day-to-day functionality and quality of life. The proposed settlement may mean that future coverage will be based on the need for skilled care, rather than the potential for improvement.

How the Medicare Rules Will Change

If the settlement agreement is approved, there will be changes to the manual that Medicare contractors use to process claims: those processing claims would no longer evaluate cases based on potential for improvement, but rather on the need for skilled care—even if that care only slows deterioration or maintains a person’s current condition.

“The changes will apply to the traditional Medicare program and to private Medicare Advantage plans. They apply to people 65 and older, as well as to people under 65 who qualify for Medicare because of disabilities,” reports the New York Times. Not only that, individuals who have been denied coverage in the past may be able to resubmit claims.

Increasing Opportunities for Families and Caregivers

These changes may help families afford services such as in-home care and various types of outpatient and inpatient nursing treatment, easing the personal and financial burden on caregivers. Patient advocacy groups hope that more types of therapy will be covered, improving day-to-day health and reducing the need for hospital visits. However, there will likely still be consumer costs associated with long-term care insurance and extended nursing home stays.

Have you or a loved one ever been turned down by Medicare due to lack of potential for improvement? Did you appeal, or do you plan to resubmit you claim? We want to hear from you in the comments!

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