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 their tab. And new supplemental benefits are making Medicare Advantage an even more appealing option going into 2020.
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), impose their own networks, and set their own rules. In other words, they’re less standardized than Original Medicare, where enrollees can see 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.
Many of these new benefits relate to quality of life more so than treating an actual medical condition. For example, under the new rules, Medicare Advantage plans can now pay for these 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.
Will you qualify for supplemental benefits?
The Centers for Medicare & Medicaid Services estimates that Medicare Advantage premiums will drop across the board in 2020, while plan benefits are expected to increase. But before you get too excited at the idea of signing up for a cooking class on your insurer’s dime, know this: These new supplemental benefits 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 any of these added perks. 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.
Weighing your options
To be clear, not all Medicare Advantage plans will offer these new supplemental benefits, though it’s estimated that 12% will offer them in 2020. And, as mentioned, having a plan that includes these benefits doesn’t guarantee that you’re eligible for them. But if you are interested in pursuing these new benefits, it pays to assess your choices during Medicare’s open enrollment, which runs until December 7 this year. During open enrollment, you can switch from original Medicare to an Advantage plan, or switch from one Advantage plan to another.
You can also sign up for a new Medicare Advantage plan during the Medicare Advantage open enrollment period (from January 1 to March 31 annually). During this time, you can only make changes if you’re enrolled in a Medicare Advantage plan, and you’re limited to a single plan switch (as opposed to Medicare’s fall open enrollment, when you can switch back and forth between Original Medicare and Medicare Advantage multiple times).
This means that you can switch from your existing Advantage plan to another if you find one that offers better supplemental benefits. You can also revert back to original Medicare during the Advantage open enrollment period, but if you do, those supplemental benefits are off the table.
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.