A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare. These items or services 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:
Supplemental benefits must, with some exceptions (see In 2020, What Types of Supplements Benefits do Medicare Plans Cover?), be primarily health-related. These benefits can either be:
- Optional, meaning that they are offered to everyone who is enrolled in a plan, and you can choose to purchase coverage if you want to (for example, an optional dental benefit for which you can pay an additional premium to your Medicare Advantage Plan for dental benefits that are not otherwise covered by your plan), or
- Mandatory, meaning that they are covered for everyone enrolled in the Medicare Advantage Plan (for example, a gym membership benefit that is included in your Medicare Advantage Plan, for which you pay no additional premium and which you cannot decline or opt out of). Mandatory does not mean you must make use of the coverage or use the services.
Medicare Advantage Plans must follow Medicare guidelines when designing and introducing supplemental benefits. These guidelines include:
- Benefits must be medically necessary: A Medicare Advantage Plan can only cover a supplemental benefit if it is medically necessary and offered in addition to the benefits available under Original Medicare.
- Supplemental benefits must have distinct names: Medicare requires that Medicare Advantage Plans choose wording that accurately describes the supplemental benefits they are offering.
- In naming benefits, plans should not single out specific parts of the benefit: For example, if a Medicare Advantage Plan offers chiropractic visits as a supplemental benefit, it should refer to the benefit that way. The plan should not indicate that massage will be covered, even though massage may be included in a visit to a chiropractor.
- Benefits cannot be offered to non-enrollees: Medicare Advantage Plans cannot cover services that will be used by people other than the members that are enrolled in their plan, except in cases when Original Medicare also covers those services.
- For example, a Medicare Advantage Plan cannot cover a gym membership for an enrollee’s spouse or child. Medicare Advantage Plans also cannot offer any type of caregiver support as a supplemental benefit, unless that type of support is covered by Original Medicare, (for example, respite services for the caregivers of those receiving hospice benefits are covered by Original Medicare).
Beginning in 2020, plans can also offer additional supplementary benefits which are not primarily health-related. These benefits may only be made available to plan members with certain chronic conditions (see In 2020, What Types of Supplements Benefits do Medicare Plans Cover?).
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