As you or your parents get older, healthcare costs can include far more than prescription drugs and doctor co-pays: As you age and become less mobile, you may also have to spend money on upgrades to stay safe at home.

In this week’s column, Phil Moeller, the author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs and co-author of the updated edition of How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security, answers two reader questions about what home improvements Medicare will cover.

Got a question of your own about Medicare or Social Security? Send it to askphil@considerable.com.

Will Medicare Advantage cover a ramp for my mother?

Karen: I just read about Medicare changes for 2019 and a widening view of home safety adaptations. I am writing you to request guidance in ending my relentless Google searches on this topic!

Our scenario: My mother is a relatively healthy 77-year-old who lives on 14 acres with two dogs, three horses, and an atypical Parkinsonism tau protein disorder diagnosis (PSP/CBD). This is a neurodegenerative movement disorder that results in balance issues and lots of falls.

She wants to remain as independent as possible at home. Her entryway is a deck with eight steps leading to it. A few months ago, she fell backward down these steps. So now we need a ramp, which would be about $2,500 to build.

We are fortunate and ready to self-pay it. But I have read a number of references from you and others regarding a new group of benefits to help people safely age in place, as well as a more generous view of home safety adaptations.

Her primary care doctor approached her Medicare Advantage insurer to ask about coverage for such an entry ramp. The insurer’s response was, “Medicare doesn’t pay for that, so we won’t cover it.” This seems contrary to what I have read; yet I am unable to locate anything from the Centers for Medicare & Medicaid Services (CMS) or on the Medicare.gov website that addresses the matter.

I feel responsible for using my mother’s resources wisely and a bit of a commitment to have this corrected if her insurer has simply not communicated 2019 changes to its organization and staff effectively.

Would you direct me to a documentation to effectively support my argument or correct me if I am wrong?

Phil Moeller:Gold stars for wanting to help your mom, and for doing your homework. 

These non-medical benefits (that’s my shorthand, not Medicare’s language) are not fully spelled out by Medicare, but the agency has indicated it would look favorably on insurers who proposed them. Here’s the 2018 CMS memo that lays out the agency’s initial description of these benefits.

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These new Medicare Advantage benefits might include equipment to keep older adults safe at home, such as grab bars, temporary ramps, and stair rails. 

Insurers do not have to offer these benefits, and if they do, they have a lot of discretion about what to offer.

This year is the first year such benefits are possible. The timing of the 2018 CMS guidance memo did not leave insurers much time to develop new benefit rules, and relatively few insurers have included them in their 2019 Medicare Advantage plans. UnitedHealthcare, in particular, said at the time that it would take a conservative approach and did not make much use of these new benefits in its 2019 plans.

The bottom line, as I see it, is that insurers may but do not have to offer these benefits, and if they do, they have a lot of discretion about what to offer and whether to offer it to all policyholders in a plan or to a select few.

(The ability of Medicare Advantage plans to pick and choose who gets benefits is a new tool given to them by Medicare and, I suspect, will create many fairness issues down the road.)

So, her insurer’s response is correct. And even among insurers offering these expanded benefits, I would be surprised to find one who would now cover a $2,500 ramp.

If her primary physician prescribes physical therapy as being medically necessary, Medicare will cover it.

Having said this, I would not give up hope for the future. Earlier this month, CMS issued its formal notice to Medicare private health plans about changes it is seeking in 2020 plans. This notice included providing Medicare Advantage plans even more flexibility to offer non-medical benefits next year. Even before this notice, MA plans were expected to boost their non-medical offerings next year. 

Also, while you may need to pay for your mom’s ramp, there is a good possibility that Medicare would cover at least some of her physical therapy. If her primary physician prescribes such care as being medically necessary, Medicare will cover it. And coverage of this benefit does not hinge on whether the therapy will actually improve her health, just that it will help her. 

Good luck, and please let me know if you need any other information about Medicare coverage for your mom.

Will Medicare cover a special chair?

Question: I have very bad knees. Can Medicare pay for a chair/recliner that lifts you to a standing position so I then can walk?

Phil Moeller: I’m sorry to hear about your knees. Generally, Medicare only covers care and equipment that is considered medically necessary by your doctors or other licensed caregivers.

If getting help to stand up improves your health, you might be covered. However, it’s unlikely the full cost of a lift chair would be covered. More likely, only what’s called the “lift mechanism”—the tension-loaded device that elevates you—would be covered.

These units, with more modest costs, would be placed atop the seat of a sturdy chair and provide the lift benefits you need.

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