Starting in 2019, the Centers for Medicare and Medicaid Services (CMS) granted Medicare Advantage plans more flexibility to cover additional services that help seniors stay out of the hospital and safely age at home. The Bipartisan Budget Act of 2018 authorized several new changes and supplemental benefits for Medicare Advantage plans.
Because Medicare Advantage plans are offered by private insurance companies, they have traditionally offered extra benefits not available with Original Medicare. For example, many Medicare Advantage plans cover routine vision and dental care, which isn’t covered under Part A and Part B.
Prior to the new budget act, Medicare Advantage plans were very limited in the type of over-the-counter products and home care services they could cover. Now, however, there is more leeway for plans to offer additional benefits to plan members and their caregivers.
An independent research firm surveyed Medicare Advantage plans and discovered that nearly 50% will be adding one or more of the new supplemental benefits in 2019, with nearly 70% upping their supplemental benefit offerings in 2020.
Here’s a look at some of the different types of supplemental benefits you may be able to get with Medicare Advantage this year.
Nicotine replacement therapy
If you use a nicotine patch or nicotine gum or other type of nicotine replacement product, your Medicare Advantage plan may now pay for it. About half of all plans indicated they would offer this benefit in 2019.
Over the counter benefits
Coverage of over-the-counter items is expanded to include things like pill cutters and pill crushers, personal activity trackers, and digital thermometers. Some plans provide a monthly allowance for covered OTC items. Plans may choose which additional OTC items they will cover; the benefit is not standardized for all Medicare Advantage plans.
Medicare Advantage plans may now cover adult daycare, respite care, and counseling and training sessions for people caring for a Medicare Advantage plan member. The benefit may be limited to a certain number of hours, or capped at a certain dollar amount for the plan year.
In-home support services
In the past, coverage for home health services was limited to medical therapies and skilled nursing care. Now, some Medicare Advantage plans will cover housekeeping services, meal delivery, and even aides to help with activities of daily living such as bathing, dressing, and eating. The benefit is generally limited to a certain number of hours of care, such as 125, each year.
Some Medicare Advantage plans are covering the cost of transportation to and from medical and wellness visits, pharmacies, and other necessary services for qualifying plan members. The benefit might cover the cost of a fixed number of one-way trips per year using a taxi or other service like Uber or Lyft.
Home safety devices
Your Medicare Advantage plan may offer an annual allowance for purchasing or installing home safety devices such as bathroom handrails, wheelchair ramps, and reaching devices.
Other things to know about the new Medicare Advantage Supplemental Benefits
In some cases, you may need a referral from your doctor to use the supplemental benefits, and you may need to use certain providers approved by your Medicare Advantage plan.
These benefits are typically not unlimited; plans may set a monthly or yearly limit on the amount they will pay in the different benefit categories.
These benefits will be incorporated into your standard Medicare Advantage plan benefits. You won’t be charged a separate premium for these supplemental benefits as you might for other supplemental vision or dental benefits. There will be no extra charge for these benefits to plan members.
If your Medicare Advantage plan doesn’t offer many supplemental benefits in 2019, it may in 2020. The new rule was finalized at a time when most Medicare Advantage plans had already determined their plan benefits for 2019. Expect to see more plans offering additional benefits for the 2020 plan year.