Medicare covers a lot. But there are some health services that the basic Original Medicare program just doesn’t pay for. That’s where supplemental benefits come in. These are the extras that you can get by buying a Medicare Advantage plan.
Supplemental benefits may include vision checkups, hearing care, and visits to the dentist, among many other possibilities. The roster offered by various Medicare Advantage plans is wide and ever-expanding. Here’s the breakdown on what these benefits are and how they work.
What are Medicare Advantage plans’ supplemental benefits?
A supplemental benefit is any service or item covered by a Medicare Advantage plan but not covered by Original Medicare. These benefits supplement the basic Medicare benefits like medically necessary hospitalization or physical therapy that Medicare Advantage plans are required to cover.
Each Medicare Advantage plan offers its own special mix of different supplemental benefits. That’s why, when you’re choosing a plan, it’s important to ask exactly what it includes, especially if there’s a particular benefit that’s important to you.
Some of the most common supplemental benefits are visits to the optometrist, hearing aids, dental care, and reimbursement for fitness costs (such as a gym membership). Less common supplemental benefits can include acupuncture or counseling to quit smoking, though these are offered by only a minority of Medicare Advantage plans at present.
How does Medicare Advantage plan supplemental benefits work?
Unlike the benefits covered by Original Medicare, supplemental benefits don’t have to be provided by Medicare-certified facilities or doctors enrolled in Medicare. Instead, each Medicare Advantage plan has its own list of in-network providers for you to choose from. The rules of your plan govern what providers you can see, what services are covered, and how often you can use those services.
For example, let’s say you want a Medicare Advantage plan that offers vision care coverage. When you’re choosing among plans with vision care benefits, you’ll still want to look at the rules for each to find out details like how often you can get your eyes checked and how much the plan will pay toward a pair of glasses.
Some services offered by Medicare Advantage plans are mandatory, meaning that all enrollees have access to those services and they’re included in the basic fee. That doesn’t mean you have to use the service, of course. If your plan includes mandatory fitness coverage, it means you can’t pay less by opting out of that coverage. It doesn’t mean someone’s going to drag you to the gym against your will! Other coverage may be optional, meaning that you can add that service to your plan for an extra fee.
Has Medicare Advantage plan supplemental benefits changed in recent years?
In a word, yes. In the past, the supplemental coverage offered by Medicare Advantage plans had to be narrowly health-related—think vision checkups and hearing aids. However, expansions in recent years have allowed the insurance companies offering these plans to broaden their coverage.
That means Medicare Advantage plans now can (and often do) add services that cover not just medical needs, but also health maintenance. You may find plans now that cover things like adult day care, therapeutic massage, and more generous meal and transportation benefits. For example, a Medicare Advantage plan may now offer rides to the doctor, complete with a health aide to help the patient along the way.
In addition, Medicare Advantage plans can now provide plans customized for the chronically ill, including special services such as service dog support or an air purifier.
Only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a Licensed Sales Agent.
Return to: Medicare Advantage