Supplemental Benefits for the Chronically Ill or non-primarily health related Supplemental Benefits are an additional type of coverage that Medicare Advantage plans
can offer plan members with chronic illness, "if these benefits have a
reasonable expectation of improving or maintaining the health or
overall function of the patient as it relates to their chronic condition
noted by the Centers for Medicare and Medicaid Services (CMS) in the April 1, 2019, Fact Sheet
released with the
2020 Final Call Letter
, starting in 2020, Medicare Advantage plans "will have
greater flexibility to offer chronically ill patients a broader range of
supplemental benefits that are tailored to their specific needs, such
as providing meals beyond a limited basis, transportation for
non-medical needs, and home environment services."
In the Call Letter, CMS notes that Medicare Advantage plans will be responsible for
determining which of their plan members are identified as "chronically
ill" and thus able to receive the Supplemental Benefits (or SSBCI). Such Supplemental Benefits should be well received as CMS notes that about 73% of current Medicare Advantage plan
members have one or more chronic conditions (as defined or listed by CMS).
Advantage plans also will be responsible for determining whether "the
non-primarily health related benefit will have a reasonable expectation
of improving the chronic disease or maintaining the health or overall
function of the enrollee receiving the benefit".
Examples of non-primarily health related Supplemental Benefits (as provide by CMS) include:
Medicare Advantage plan could provide a plan member with asthma
coverage for "home air cleaners and carpet shampooing to reduce
irritants that may trigger asthma attacks".
- A Medicare Advantage plan could provide a plan member with heart disease coverage for "heart healthy food or produce".
Medicare Advantage plan "may offer items and services that include
capital or structural improvements (e.g., permanent ramps, and widening
hallways or doorways) if those items and services have a reasonable
expectation of improving or maintaining the health or overall function
of the enrollee as it relates to the chronic condition or illness".
When considering Supplemental Benefits, CMS reminded Medicare Advantage plans that, "SSBCI
are supplemental benefits and, therefore, must not be items or services
covered by original Medicare." In addition, CMS reminded Medicare
Advantage plans that a member's request for Supplemental Benefits was to
be treated as any other benefit request and subject to the appeals
https://www.cms.gov/newsroom/ fact-sheets/2020-medicare-advantage-and- part-d-advance-notice-part- ii-and-draft-call-letter
https://www.cms.gov/newsroom/fact-sheets/ 2020-medicare-advantage- and-part-d-rate-announcement-and- final-call-letter-fact-sheet, and
https://www.cms.gov/Medicare/Health- Plans/MedicareAdvtgSpecRateStats/ Announcements-and-Documents-Items/ 2020Announcement.html