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Medicare Advantage Supplemental Benefits

Lorraine York-EdbergLorraine York-Edberg, SHINE Regional Program Director

What is a supplemental benefit?

A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare. These benefits do not need to be provided by Medicare providers or at Medicare-certified facilities. Instead, to receive these items or services, you need to follow your plan’s rules. Some commonly offered supplemental benefits are dental care, vision care, hearing aids, and gym membership. Medicare Advantage supplemental benefits are not to be confused with Medicare supplemental insurance, also known as a Medigap policy. Medigaps are health insurance policies that pay for some Original Medicare out-of-pocket costs.

Changes to supplemental benefits in 2020

Beginning in 2020, Medicare Advantage Plans can begin covering supplemental benefits that are not primarily health-related for beneficiaries who have chronic illnesses. These benefits should address environmental factors that may affect the health, functioning, quality of life, and risk levels of beneficiaries with chronic conditions. Some examples of the new benefits are meal delivery, transportation for non-medical needs, and home air cleaners.

Some examples of the new benefits are meal delivery, transportation for non-medical needs, and home air cleaners.

In order to be eligible for this new category of supplemental benefits, you must be considered chronically ill.

  • Have at least one medically complex chronic condition that is life-threatening or significantly limits your health or function
  • Have a high risk of hospitalization or other negative health outcomes, and
  • Require intensive care coordination

If you meet these criteria, a Medicare Advantage Plan may offer you one of these new benefits if it has a reasonable expectation of improving or maintaining your health or function. Medicare Advantage Plans will be able to create sets of supplemental benefits for people with specific chronic illnesses, which means not every member of a Medicare Advantage Plan will have access to the same set of supplemental benefits.

Example in Western Massachusetts: One of our plans offers meals to members discharged from an inpatient stay at a hospital, within 30 days. This benefit includes 28 fully prepared meals delivered to the members’ homes at no cost. This benefit is unlimited and offered after every inpatient discharge.

Who can I call if I have further questions?

If you have Original Medicare, call 1-800-MEDICARE to learn more about what services are or are not covered under Original Medicare.

Call your Medicare Advantage Plan to learn about its costs and coverage rules for supplemental benefits. If you are thinking about enrolling in a new Medicare Advantage Plan, call the plan first to confirm that you understand the costs and coverage.

If you need help understanding your benefits or filing an appeal, contact your State Health Insurance Assistance Program also known as SHINE in Massachusetts.

Portions of this article have been written in cooperation with The Medicare Rights Center.

The SHINE program, Serving the Health Insurance Needs of Everyone, provides confidential and unbiased health insurance counseling for Medicare beneficiaries. This is a free service, though contributions are welcome and will go a long way to help support this vital program. For further assistance with any Medicare issue, you can make a SHINE appointment. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555, or contact your local council on aging.