Medicare Advantage Supplemental Benefits for 2019
Medicare Advantage may provide extra benefits that set these plans apart from Original Medicare (Part A and Part B).
Starting in 2019, Medicare Advantage plans may offer even more supplemental benefits than before. If you’re browsing Medicare Advantage plans, here’s everything you need to know about these new supplemental benefits and how they may affect you.
Medicare Advantage plans and supplemental benefits
For those unfamiliar with the Medicare Part C (Medicare Advantage) program, Medicare Advantage plans are health plans offered by Medicare-approved private insurance companies as an alternate way to get your Original Medicare benefits. Medicare Advantage plans must offer at least the same level of coverage as the federal program, but can also provide additional benefits that go beyond Part A and Part B, such as wellness programs. These extra benefits may vary from plan to plan.
Before, Medicare Advantage plans could only offer optional benefits that met Centers for Medicare & Medicaid Services (CMS) standards. CMS used to define a supplemental benefit as an item or service that:
- Is not already covered by Original Medicare, Part A and Part B.
- Is primarily “health-related.” This means the main purpose must be medical (for example, to prevent or treat an injury or condition). It couldn’t be for comfort, maintenance of health, or cosmetic reasons.
- Is provided by the Medicare Advantage plan at a cost to the plan. Administrative cost alone doesn’t count.
Under this definition, Medicare Advantage plans could not offer supplemental benefits that didn’t have a primary purpose that was health-related.
Medicare Advantage plans expand supplemental benefits for 2019
Recently, CMS released a new policy update affecting benefits for Medicare Advantage plans in the 2019 plan year. This new policy expands the definition of Medicare Advantage supplemental benefits to those that aren’t covered by Original Medicare, and:
- Diagnose or reduce the impact of injuries and conditions
- Reduce avoidable emergency room visits
Medicare Advantage plans may now offer benefits that “are not necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees.” Under the new guidelines, Medicare Advantage plans have greater flexibility to offer supplemental benefits for members with chronic conditions.
In other words, a Medicare Advantage plan may now offer a broader range of supplemental benefits that may not seem directly health-related, but improve or maintain the overall health of its members.
The CMS press release cited carpet shampooing and air cleaners as examples of items that might be covered by Medicare Advantage plans to serve members with asthma. These items wouldn’t have qualified as “health-related” in the past. But the new guidelines might let plans cover them to improve or maintain the health of patients with chronic asthma. Carpet cleaning and air cleaners might keep an asthma patient healthy by reducing the risk of asthma attacks and emergency room visits.
As another example, non-medical transportation (such as trips to the grocery store) wouldn’t have previously been covered by Medicare Advantage plans, but might now be covered for beneficiaries with chronic conditions.
What supplemental benefits may Medicare Advantage plans offer?
Medicare Advantage plans have long offered a wide range of supplemental benefits, which may include, but isn’t limited to:
- Routine vision services, including eye exams, contact lenses, glasses, and more
- Routine dental services, including cleanings, extractions, and more
- Hearing, including hearing exams and fittings for hearing aids
- Chiropractic services
- Wellness programs
- Telemedicine services or nursing hotlines via phone or the web
- Certain over-the-counter supplies and/or medications (e.g., bandages, toothbrushes)
- Medical alert devices that alert dispatchers in case of a health emergency, such as a fall
- Wigs for hair loss from chemotherapy
Under the expanded guidelines, Medicare Advantage plans may also now offer new supplemental benefits in certain cases. These benefits must be geared toward improving or maintaining the enrollee’s health:
- Meal delivery or transportation for non-medical needs like grocery shopping
- Non-emergency, non-medical transportation for needs connected to improving the patient’s health condition (e.g., grocery shopping)
- Adult day care services
- In-home support services
- Home environment services
Keep in mind that you might not qualify for every supplemental benefit. Also, Medicare Advantage plan benefits may vary by plan and location, so always check details with the specific plan you’re considering for more information.
Finding Medicare Advantage plans
eHealth’s plan finder tool makes it easy to compare Medicare Advantage plans from the convenience of your home or phone. To get started right now, simply enter your zip code into the box to browse Medicare Advantage plan options in your location.