What is a Supplemental Benefit?
You may notice that your Medicare Advantage Plan (MAP) offers benefits not covered by Original Medicare. Medicare Advantage Plans call these supplemental benefits. These are benefits that may not be Medicare-approved providers or facilities because they are items and services covered by your individual MAP provider. The Medicare Advantage plan rules govern these benefits rather than Medicare itself. Although some benefits vary among Plan providers, most supplemental benefits are dental or vision care, hearing aids, and “Silver Sneakers” memberships at participating gyms.
Most supplemental benefits are health-related and can be optional or mandatory. Optional benefits are offered to all plan enrollees and you can choose which supplemental benefits to pay for. Mandatory supplemental benefits are also covered for plan enrollees, but coverage cannot be declined whether you use the service or not.
Chronic Medical Conditions
Some supplemental benefits are not primarily health-related, but cover beneficiaries living with chronic medical conditions. According to the Medicare Rights Center, “These benefits should address social determinants of health. A social determinant of health is part of your life that can affect your health in some way, such as not having access to transportation.”
In other words, these Plans can offer benefits that are not primarily health-related: things like meal delivery, transportation for non-medical needs such as grocery shopping, and home air cleaners. These also vary among MAP providers and you must be chronically ill to receive these benefits. To considered chronically ill, you must meet each of the following requirements:
· Have at least one medically complex condition that is life-threatening or significantly limits your health or function
· Have a high risk of hospitalization or other negative health outcomes
· Require intensive care coordination
Medicare Advantage Plans create sets of supplemental benefits for people with specific chronic illnesses so not every member of a MAP will receive the same set of benefits. The Medicare Rights Center explains:
“For example, a plan might cover services like home air cleaning and carpet shampooing for members with severe asthma. A member of that plan who has severe asthma will be able to get those services covered, while a member who does not have asthma, or whose asthma is mild, will not.”
Other Supplemental Benefits
Many Medicare Advantage Plans offer Vision and Dental supplemental benefits since these benefits are not covered by Original Medicare except under certain conditions. Things such as routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, if you have a chronic eye condition, such as cataracts or glaucoma. Medicare will cover:
· Surgical procedures to help repair the function of the eye due to chronic eye conditions. For example, Medicare will cover surgery to remove a cataract and replace your eye’s lens with a fabricated intraocular lens.
· Eyeglasses or contacts if you had an intraocular lens placed in your eye after cataract surgery. Then Medicare will only cover a standard pair of untinted prescription eyeglasses or contacts if you need them (unless customization of glasses or contact lens is medically necessary).
· If you are having vision problems that may indicate a serious eye condition, Medicare will cover an exam. Your exam is covered even if it turns out you do not have a vision problem.
(Exception: Medicare only covers routine eye care if you have diabetes or are at a high risk of glaucoma.)
Dental services that are needed primarily for the health of your teeth, such as routine check-ups, cleanings, fillings, dentures and tooth extractions are not covered by Medicare. There are exceptions, just as with vision issues, but you will normally be responsible for the full cost of these services. A Medicare Advantage Plan may provide the supplemental benefits to assist you with these issues.
Supplemental benefits may affect the Medicare options you choose, so choose wisely.