When a new year begins, why do so many individuals forget about the additional (supplemental) benefits that are included in their Medicare Advantage (MA) plan? These additional benefits may include dental, vision, hearing, transportation, meals, over-the-counter products, and fitness memberships just to name a few! Not taking advantage of these extras could cost an MA member hundreds of dollars in missed savings!
Previously, supplemental benefits had to be “primarily health-related.” However, guidance released in 2018 by The Centers for Medicare and Medicaid Services (CMS) provided a reinterpretation of “primarily health related” to expand the scope and flexibility of benefits. These benefits now take into consideration the whole person as well as other social determinants of health and quality of life metrics. MA plans must cover all the benefits offered by Original Medicare and offer an increasingly larger and more varied assortment of options, services, and plan flexibility than ever before! These additional benefits, not offered in Original Medicare, may help members remain in their own homes, avoid social isolation and lead longer and healthier lives…and many of these Medicare Advantage plans have a $0 dollar monthly premium.
Needs and priorities are different for every individual and change as we age. Dental health becomes increasingly more important as we get older because of recent studies that link good dental hygiene with better heart health. Dental insurance, however, is expensive and many folks perceive the value from stand-alone plans as marginal. Some MA plans in North Carolina offer a dental reimbursement of up to $500 annually to cover the cost of preventative services like cleanings and x-rays, while others have point-of-service plans that help with comprehensive services that feature much greater savings.
For some individuals, hearing aids may be a priority while others focus on the need for vision services and new spectacles! Those who live alone might need the extra safety and security provided by a personal emergency response system (PERS) or transportation and meals after a surgical stay. Some plans even offer over-the-counter quarterly allowances for health related products like pain relievers, incontinence supplies, bandages and braces. Most every Medicare Advantage plan offers a fitness membership to a local health and wellness facility.
For dual special needs individuals, those with both Medicare and Medicaid, the benefits could be even greater!
But don’t believe everything you see or hear on TV or through social media, because plan benefits can vary greatly! Plans differ from state to state and even by counties within the same state. Benefits offered by Health Maintenance Organizations (HMOs) may differ from those offered by Preferred Provider Organizations (PPOs). Benefits may operate as “point-of-service” and others may have “in-network” restrictions. This may all seem complex, but with a little effort, members can reap big rewards!
To gain the most value from an MA plan, members should consider these three easy steps.
- Become familiar with the Summary of Benefits document that was provided by your representative at time of enrollment. This document summarizes the benefits!
- Review the Welcome Package and Evidence of Coverage (EOC) materials that come to your mailbox (or electronically) after enrollment. The EOC provides more comprehensive details about plan benefits and instructions about how to set up accounts and access products and services.
- Contact member services or the third party service provider for additional information and/or to activate services.
Finally, contact your local insurance professional who represents multiple insurance companies! They will be familiar with all the plan benefits and can provide valuable guidance to compare and contrast available plans that meet individual needs and circumstances. Look for an established company with Certified Senior Advisors (CSA®) who offer FREE consultations. The extra effort needed to understand your Medicare Advantage plan and its supplemental benefits could be worth thousands of dollars and improve quality of life for its member and their family!