services are provided by a Medicare certified agency, and medically necessary. 134 Medicare Part B also covers medically necessary home health services delivered by Part B providers. 135 Each year, those eligible for Medicare may choose to opt out of Original Part A and Part B (Supplementary Medical Insurance) Medicare and instead enroll in a Medicare Advantage Plan (MAP) under Medicare Part C. 136 The Medicare Advantage option has been growing in popularity in various parts of the U.S., 137 despite the overt antagonism of the Obama administration toward this private sector approach, as reflected in the ACA. 138 When an individual selects this option, the Medicare program pays a periodic fee to one of the managed care (Health Maintenance Organization or Preferred Provider Organization) or private fee-for-Service plans operating in the Medicare enrollee’s geographical area, and in consideration of that periodic fee, the Plan agrees to provide the enrollee or be responsible for the provision of, at the least, all services that would have been covered under Original Medicare. 139 This includes the LTSS that Original Medicare covers. 140 Different MAPs, for marketing reasons, offer different service coverage packages over and above the basics required to match Original Medicare (for example including vision, hearing, and dental care coverage), and similarly may differ regarding deductibles, co-pays, and co-insurance imposed on the
134. 42 C.F.R. § 409.42 (2012); see generally VICTORIA WEISFELD & TRACY A. LUSTIG, THE FUTURE OF HOME HEALTH CARE: WORKSHOP SUMMARY (2015) http://www.nap.edu/read/ 21662/chapter/1. These services may include, for example, part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for people with a continuing need for occupational therapy. 135. 42 U.S.C. § 1395k (a)( 2)( A) (2011). 136. 42 U.S.C. § 1395w– 21 (2015). 137. Robert Pear, As Medicare and Medicaid Turn 50, Use of Private Health Plans Surges, N. Y. TIMES (July 29, 2015), http://www.nytimes.com/2015/07/30/us/as-medicare- and-medicaid-turn-50-use-of-private-health-plans-surges.html?_r=0 ; Medicare Advantage Premiums Remain Stable; Enrollment at All-Time High, CTRS. FOR MEDICARE & MEDICAID SERVS. (Sept. 21, 2015), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press- releases/2015-Press-releases-items/ 2015-09-21.html; see also Tricia Neuman et al., Medicare Advantage and Traditional Medicare: Is The Balance Tipping?, HENRY J. KAISER FAM. FOUND. 1 (Oct. 2015) http://files.kff.org/attachment/issue-brief-medicare-advantage-and- traditional-medicare-is-the-balance-tipping. 138. See Richard L. Kaplan, Reflections on Medicare at 50: Breaking the Chains of Path Dependency for a New Era, 23 ELDER L.J. 1, 24-26 (2015); Gretchen Jacobson et al., Medicare Advantage 2015 Spotlight: Enrollment Market Update, HENRY J. KAISER FAM. FOUND. 1 (June 2015), http://files.kff.org/attachment/issue-brief-medicare-advantage-2015-spotlight- enrollment-market-update (“Despite concerns that reductions in payments to Medicare Advantage plans enacted in the Affordable Care Act of 2010 (ACA) would lead to reductions in Medicare Advantage enrollment, the number and share of Medicare beneficiaries enrolling in Medicare Advantage plans has continued to climb.”). 139. See supra notes 132-134. 140. Id.