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What are some of the Supplemental Benefits provided by Medicare Advantage plans?


Medicare Advantage plans provide coverage for Medicare Part A (in-patient, hospitalization), Medicare Part B (out-patient, doctor visits), and maybe Medicare Part D (prescription drug coverage from an MAPD).  Medicare Advantage plan may also include supplemental benefits that are not normally offered by Original Medicare such as gym memberships, vision care, hearing care, and routine dental coverage.

In 2019, the Centers for Medicare and Medicaid Services (CMS) expanded supplemental benefits to include both health related and non-health related benefits (for the chronically ill).

Special 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 or illness."

Now, health related and non-health related supplemental benefits offered by some Medicare Advantage plans may include:
  • fitness center or gym memberships
  • routine vision care (exams, eye glasses)
  • routing hearing care (exams hearing aids)
  • dental services (cleanings, extractions, dentures)
  • chiropractic service
  • acupuncture
  • telemedicine (expanded with the outbreak of COVID-19)
  • OTC or allowance for over-the-counter items
  • transportation for medical and non-medical related reasons
  • pest control
  • home cleaning services
  • home meal delivery
  • adult day health services
  • caregiver support services
  • in-home support services
  • therapeutic massage
  • home-based palliative care
We show many of the Medicare Advantage plan supplemental benefits in our Medicare Advantage plan finder coverage details (https://MA-Finder.com) and this information can be found down toward the bottom of the coverage detail pages.

Here is an example showing the additional or supplemental benefits provided by the St. Johns County, Florida (32084) 2020 Humana Gold Plus - Diabetes (HMO C-SNP) (designed for Medicare beneficiaries with Diabetes Mellitus):

Q1Medicare Medicare Advantage Plan Finder showing Supplemental Benefits
More background on the Medicare Advantage plan Supplemental Benefits

As 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).

Medicare 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:
  • A 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".

  • A 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 process.
CMS added to the description of healthcare and non-healthcare related supplemental benefits that are offered by Medicare Advantage plans in the press release announcing 2021 Medicare Part D and Medicare Advantage plans:
[In 2021, there will be m]ore opportunities for seniors to choose from Medicare Advantage plans that provide extra healthcare benefits to keep people healthy. In 2021, about 730 plans will provide about 3 million Medicare Advantage enrollees with these additional types of supplemental benefits, such as
  • adult day health services,
  • caregiver support services,
  • in-home support services,
  • therapeutic massage, or
  • home-based palliative care, that are primarily health related under a new interpretation adopted beginning with 2019. [formatting added]
. . . About 920 [2021 Medicare Advantage] plans reaching 4.3 million beneficiaries will offer non-primarily health related benefits tailored to people with chronic conditions that may help them better manage their disease(s). Examples of these benefits include
  • pest control,
  • home cleaning services,
  • meal home delivery, and
  • transportation for non-medical reasons such as trips to the grocery store. [formatting added]
References:

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

https://www.cms.gov/newsroom/press-releases/trump-administration-announces-historically-low-medicare-advantage-premiums-and-new-payment-model





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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.