Beginning in 2020, Medicare Advantage Plans have increased flexibility in offering coverage of supplemental benefits. A supplemental benefit is an item or service that is 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.
This year, Medicare Advantage Plans can cover 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.
Examples of the kind of benefits that plans can now cover are:
- Meal delivery
- Transportation for non-medical needs
- Home air cleaners
- Pest remediation
- Heart-healthy food or produce
In order to be eligible for this new category of supplemental benefits, you must be considered chronically ill. This means that you:
- Have at least one medically complex chronic condition that is life-threatening or
significantly limits your health or function
- Medically complex chronic conditions include cardiovascular disorders, diabetes, chronic lung disorders, neurologic disorders, chronic heart failure, chronic and disabling mental health conditions, cancer, dementia, chronic alcohol or drug dependence, autoimmune disorders, stroke, end-stage renal disease (ESRD), severe hematologic disorders, end-stage liver disease, and HIV/AIDS.
- Have a high risk of hospitalization or other negative health outcomes, and
- Require intensive care coordination
If you meet the above 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.
Since Medicare Advantage Plans will be able to create sets of supplemental benefits for people with specific chronic illnesses, not every member of a Medicare Advantage Plan will have access to the same set of benefits. For example, a plan might cover services like home air cleaning and carpet shampooing to its members who have asthma. A member of that plan who has asthma will be able to get these services covered, while a member who does not have asthma will not.
These changes mean that there may be more Medicare Advantage Plan options available in 2020, and it may become more complicated to compare these options. Remember to carefully review your Medicare Advantage Plan’s Evidence of Coverage and any other materials from your plan. If you need help understanding your plan’s benefits or reviewing your coverage options, call your To contact your SHIP, call 877-839-2675 or visit www.shiptacenter.org.
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