By Giselle Torralba and Nancy Archibald, Center for Health Care Strategies
Family caregivers are a vital part of the care and support network of older adults, who make up one of the fastest-growing populations in the United States. Often referred to as “informal caregivers,” family caregivers provide a range of assistance to help manage the care of loved ones and support their ability to age at home, typically filling gaps in the formal care delivery system. However, family caregivers often are unpaid for this care, and many are either unaware of, or struggle with accessing, supports to help them look after both themselves and their loved ones.
Medicare Advantage (MA) plans have traditionally offered supplemental benefits that are primarily health related, including but not limited to dental, vision, and hearing services, as well as medical transportation, fitness benefits, and debit cards for purchasing over-the-counter medications and other necessities. Starting 2019 after federal guidance, MA plans can offer a broader range of non-medical supplemental benefits, including expanded transportation and meal services, adult day care, community-based services, and supports for caregivers of MA plan enrollees.
Recognizing the importance of family caregivers and the services they provide, some MA plans have capitalized on these new flexibilities to better support this critical workforce. In 2021, 95 plans offered caregiver supports as part of their benefit package, with that number jumping to 160 for 2022, representing a 68 percent increase. This blog post discusses the value of supporting family caregivers and highlights the activities of two MA plans ― UCare in Minnesota and UPMC Health Plan (UPMC) in Pennsylvania ― including the considerations that factored into offering these benefits and the family caregiver supports they provide.
Benefits of Supporting Family Caregivers
Supporting family caregivers in recognition of their vital role in the health care delivery system for older adults is a growing policy priority. As the number of older adults grows, so does the number of family caregivers, underscoring the need to focus on interventions to support both of their needs. Moreover, the COVID-19 pandemic has exacerbated the shortage of paid caregivers that only increases the burden on unpaid, informal family caregivers. The current generation of adults reaching age 65 often caring for themselves as well as aging parents, underscoring the need to consider not just the plan member but the individuals doing the caregiving.
UPMC identifies and addresses both the needs of members and their caregivers, acknowledging that the latter are under significant stress facing burnout, depression, and guilt. Offering a caregiver supports benefit is one way UPMC delivers on a concept it refers to as the “care neighborhood,” which takes into account the member’s entire network of services and identifies where additional supports are required to ensure stabilization and health maintenance or improvement. It takes a holistic approach to member management that emphasizes the importance of also managing family caregivers’ quality of life. So far, the plan has seen a positive return on its ability to increase awareness of available supports among its members, with more and more caregivers taking advantage of the benefits.
Considerations Around Offering Caregiver Supports as a Supplemental Benefit
Plans take several factors into account when deciding the supplemental benefits to offer. These typically include:
- Limited rebate dollars. MA plans must fund all supplemental benefits, both those that are primarily health-related and those that address broader, whole-person needs, using what are known as rebate dollars. This means they must prioritize their supplemental benefit offerings against the budget they have available that year and what they can feasibly allocate. Since family caregiver supports are a relatively new offering, plans may be cautious to spend limited resources on a benefit without fully knowing its potential for member uptake or return on investment.
- Member expectations. MA plans typically design their supplemental benefit offerings to attract and retain members, especially since supplemental benefits are a significant draw for member enrollment. Offering historically popular supplemental benefits, like fitness services and debit cards, may be more important than offering family caregiver supports. Relatedly, consistency is a factor that plans often consider. Even if new opportunities arise to offer a novel benefit to its members, plans may be hesitant to do so knowing that they may opt out of offering that benefit the following year based on factors such as return on investment or change in rebate dollars.
- Competitors’ offerings. MA plans may feel the need to offer certain supplemental benefits or levels of benefits to keep pace with those provided by their competitors in the same geographic market. As a result, plans may be unwilling to risk replacing a reliable and consistent supplemental benefit with a new offering, like family caregiver supports, if there is a possibility that it might cause them to lose members to other plans.
Although these key considerations may not prioritize family caregiving supports as a supplemental benefit, especially when weighing against more consistent or popular offerings, both UCare and UPMC found value in supporting family caregivers, especially since caregiver supports are not covered by traditional medical benefits.
Types of Caregiver Supports Provided
MA plans offer various types of caregiver supports as supplemental benefits that can differ in how they are delivered. UCare leverages an existing relationship with M Health Fairview, a trusted care system partner, to offer a one-hour telephonic caregiver counseling session at no cost to enrollees. Because this is a newly expanded offering from UCare, the plan is starting smaller scale and monitoring member interest and use over the first year. If there is significant demand, UCare may expand the benefit, given noted growth in popularity of caregiver support among beneficiaries. UCare’s unique model, based on partnering with M Health Fairview for caregiver support, also includes additional enrollee support services. By packaging the caregiver benefits under a broader enrollee assistance program that includes mental health and well-being support as well as referral services, it fosters an authentically driven focus on holistic care.
UPMC offers similar supports in collaboration with community partners. Under the plan’s caregiver supports benefit, caregivers can receive up to six counseling sessions at no cost to help deal with various stresses, including when loved ones are in palliative care. Additionally, they have access to a six-week online course where they can gain skills in stress management, coping, and other supports or modifying behaviors to employ when fulfilling their caregiver role. UPMC has found that the benefits provide an opportunity for caregivers and members to discuss their feelings and develop helpful coping skills. For individuals who feel isolated and alone, these services are a way to get support and build the tools they need to successfully manage the care of their loved ones.
MA plans have only recently been able to provide caregiver supports benefits, and those that have done so are already beginning to understand the value. UPMC appreciates offering caregiver supports for members when they need them and is assessing how to grow the number of people connected to its caregiver programs. Additionally, it is committed to educating providers and communities to increase member uptake of these benefits. Likewise, UCare anticipates that its data will show a rise in use of caregiver supports during 2021.
This emphasis on supporting family caregivers comes at a critical time. As the pandemic’s impacts amplify health care worker shortages, the number of people who need long-term care grows and MA enrollment increases, health plans have an opportunity to support older adults and their caregivers through supplemental benefits.
Thank you to the following individuals who helped to inform this blog post:
- UCare: Stephanie Schwartz, Vice President, Government Relations; Keith Asmussen, Medicare Product Manager
- UPMC Health Plan: Donna Doebler, Associate Vice President, Medicare SNP Product; Angela Perri, Chief Medicare Officer
- ATI Advisory: Tyler Cromer, Principal; Elexa Rallos, Analyst