Some Medicare Advantage plans may have supplemental benefits. These are services that Original Medicare cannot cover. But not all supplemental benefits are the same. This blog covers what to know about them.
First, let’s understand supplemental benefits.
Some Medicare Advantage plans may cover items or services that, by law, Original Medicare cannot cover. These supplemental benefits may include dental care, vision care, or hearing aids. They should be primarily health related.
Some supplemental benefits are optional. This means you can choose to add the coverage for an extra cost. Other supplemental benefits are given to everyone in the plan, regardless of whether you use it. For example, you might choose to pay extra for dental coverage as part of your Medicare Advantage plan. And you might have a gym membership automatically included in your plan.
Do not confuse Medicare Advantage supplemental benefits with Medicare supplemental insurance. Supplemental policies are also called Medigaps. They work only with Original Medicare.
Plans can cover certain supplemental benefits for people who have chronic illnesses.
Unlike other supplemental benefits, these do not have to be primarily health-related. Instead, these benefits can address parts of someone’s life that affect their health in some way. For example, a plan might cover home air cleaning and carpet shampooing for members with asthma. A member of that plan who doesn’t have asthma could not access those services. Other supplemental benefits for people with chronic conditions might include meal delivery, transportation, or heart-healthy food. To be eligible for these benefits, you must be chronically ill.
Ask the right questions to plans that offer supplemental benefits.
You might be interested in a plan that offers these extra benefits. If so, learn as much as possible before enrolling in the plan. It’s possible to assume that a plan’s supplemental benefits cover more than they do. For example, you might assume a plan’s dental benefit covers fillings and x-rays, but it only covers yearly cleanings.
It’s important to know exactly how a plan’s supplemental benefits work before signing up. Make sure to document calls and get information in writing. Ask questions like:
Know that Medicare Advantage supplemental benefits aren’t the only way to access such services. If you learn a plan isn’t a good fit for you, you can keep Original Medicare and access needed care in other ways. Contact your State Health insurance Assistance Program (SHIP) for help finding local resources and access to such services. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
And look out for marketing misrepresentation.
Medicare has rules about how Medicare Advantage and Part D plans can contact you and market their services. It is a marketing violation to mislead Medicare beneficiaries when selling private plans.
When it comes to supplemental benefits, remember that these are items and services that Original Medicare cannot cover. Each Medicare Advantage plan determines exactly what the benefit looks like—from how expansive or restrictive the coverage is, to the rules beneficiaries must follow to get coverage. They might enforce rules such as using certain providers or having caps on how much the benefit can be used. When selling plans, agents or brokers should not mislead you into thinking that the plan’s supplemental benefits are more generous or less restrictive than they are. The following are examples of marketing misrepresentation of Medicare Advantage supplemental benefits:
If you feel you have experienced misleading marketing, save all the information such as an agent's business card, messages, marketing handouts, or other contact information. You should report this to your local Senior Medicare Patrol (SMP) or State Health Insurance Assistance Program (SHIP) and they can help you review the concern and report it to CMS as a potential marketing violation. Contact your local Senior Medicare Patrol using the SMP Locator or by calling 877-808-2468.
Your local SHIP can also help you seek a Special Enrollment Period (SEP) to switch plans if you are misled into a plan that does not cover the services you need. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
Still have questions?
Your SHIP is here for you! You can contact your SHIP for any Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
If you think you have experienced potential Medicare fraud, errors, or abuse contact your local Senior Medicare Patrol using the online SMP Locator or by calling 877-808-2468.
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