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Medicare Advantage’s supplemental benefits

A broader range of MA benefits aren't primarily health-related, but focus on improving quality of life for chronically ill beneficiaries

Insurers offering Medicare Advantage plans now have the flexibility to include more supplemental benefits – including non-emergency medical transportation.

Many seniors opt for Medicare Advantage over original Medicare because of the additional benefits associated with it. Dental care, vision screenings, and hearing aids, for example, are all non-covered services under Original Medicare, whereas Medicare Advantage plans commonly pick up some of the cost of these services. And supplemental benefits are making Medicare Advantage an even more appealing option for 2021 and 2022.

Medicare Advantage insurers are offering more benefits

As a reminder, Medicare Advantage plans are offered by private insurers but are required to offer at least the same level of coverage as Original Medicare. They charge their own premiums (though there are many zero-premium plans available, with the enrollees only having to pay the premium for Medicare Part B), impose their own networks, and set their own rules. In other words, they’re less standardized than Original Medicare, where enrollees can see almost any doctor in the United States.

These days, however, there’s a new incentive to sign up for a Medicare Advantage plan. That’s because insurers offering Advantage plans now have the flexibility to include more supplemental benefits – services that Original Medicare does not cover.

Some of these new benefits relate to quality of life more so than treating an actual medical condition. For example, Medicare Advantage plans can now pay for these relatively new services for qualifying enrollees:

  • Non-emergency medical transportation (to and from scheduled healthcare appointments)
  • Meal delivery
  • Cooking classes designed to improve beneficiaries’ diets
  • Air purifiers for the home
  • Home carpet cleanings
  • Limited home improvements and fixtures that promote safety (like shower rails)

The best part? There’s a good chance that if you qualify for these benefits, you’ll snag them at no additional cost. The reason? Insurers can now be directly reimbursed by CMS for offering these benefits.

Take an asthma patient who frequently sees a doctor or gets hospitalized for recurring attacks. If a Medicare Advantage plan were to cover the cost of a carpet cleaning or air purifier, that patient would potentially suffer fewer attacks, thereby reducing the extent to which actual medical care is needed.

Medicare Advantage supplemental benefits in 2021

An estimated one in three Medicare Advantage offers supplemental benefits related to the coronavirus pandemic in 2021, according to Avalere Health. These perks include masks, thermometers, and hand sanitizer.

And the usual supplemental benefits that have long existed on Advantage plans continue to be very widespread. As of 2021:

  • 96% of Advantage plans offer fitness benefits
  • 88% will cover hearing services
  • 92% will include dental benefits
  • 91% will have vision benefits

Benefits for homebound seniors and those with mobility issues are also more widely available in 2021, with 55% of Advantage plans offering meal benefits and 36% offering transportation to medical appointments. And virtually all (98%) Advantage plans offer telehealth benefits in 2021 – an option that’s become increasingly important in light of the pandemic.

Will you qualify for MA supplemental benefits?

Though a host of seniors may qualify for supplemental benefits related to the pandemic, some benefits, like pest control, nonmedical transportation, and home modifications, are expressly designed for enrollees with chronic health conditions.

Here’s what that means, under Medicare rules:

  • You have at least one condition that’s either life-threatening or that significantly impairs your function;
  • You have a high risk of hospitalization or negative health consequences; and
  • You require intensive coordination for your healthcare.

If you have a chronic health condition, you may qualify for supplemental benefits if it’s determined that they’ll improve your health or function. For example, as a diabetes patient, you may qualify for cooking classes that improve your diet, thereby resulting in fewer hospital visits. But if you don’t have a chronic health condition, you will not be eligible for these “lifestyle” benefits.

Furthermore, different chronic conditions may result in different benefit eligibility; much is left to the plan’s discretion. There’s no one-size-fits-all package.

But while some benefits are targeted specifically at beneficiaries with chronic conditions, the federal government also relaxed the rules, starting in 2019, for supplemental benefits that can be provided to all enrollees in a Medicare Advantage plan. Supplemental benefits provided to all enrollees have to be “primarily health related.” Prior to 2019, that was a fairly limited category of benefits that could be offered. But the definition of “primarily health related” was expanded in 2019, giving Medicare Advantage insurers leeway to offer additional supplemental benefits to all beneficiaries.

These still include the basics, such as dental and vision benefits, but they can also include more generous meal and transportation benefits, as well as things like adult day care benefits and caregiver support.

See whether you’re eligible for Medicare Advantage supplemental benefits. Talk now with a licensed Medicare advisor at 1-844-309-3504.

Weighing your options

If you are interested in pursuing these new benefits, it pays to assess your choices during the Medicare open enrollment period, which runs from October 15 to December 7. During this window, you can choose to switch to a Medicare Advantage plan if it would better meet your needs. If you already have Medicare Advantage coverage, this window is a good opportunity to compare the other available plans and see if one of them would be a better fit.

As a general rule, supplemental benefits shouldn’t be the primary factor in your decision; you’ll want to consider the plan’s main benefits, provider network, Part D drug benefits, etc. But if you’re deciding between a handful of similar plans that will all meet your needs, supplemental benefits might help you pick the one you like best.

Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.