7 Sep 20210 Comments
In 2019, more than 60 million Americans enrolled in Medicare. Many who were already enrolled changed their coverage at some point in the year. This is especially true from October 15 to December 7, Medicare’s annual open enrollment period, when enrollees can freely switch plans for health and drug coverage.
You are probably already familiar with the ads on TV, the internet and radio that promise all sorts of wonderful benefits like dental care, transportation, and even home-delivered meals if you just switch your Medicare coverage. These perks are called supplemental benefits and they are unique to Medicare Advantage Plans, but celebrities who tout these plans on the airwaves are not hired to paint the full picture.
Before we dive into supplemental benefits, it is important to address the difference between Original Medicare and Medicare Advantage. Original Medicare, often referred to as “Part A” and “Part B,” provides coverage for your health needs with payments managed federally through the Center for Medicare & Medicaid Services (CMS). Medicare Advantage, sometimes referred to as “Part C,” provides coverage through a different pricing model and is handled by private health insurance companies.
Coverage through both Original Medicare and Medicare Advantage entails monthly premiums, annual deductibles, and co-pays. Drug coverage is acquired by enrolling in a stand-alone Part D prescription drug plan if you are on Original Medicare or through a Medicare Advantage plan that includes drug coverage.
Understanding the nuances of Medicare coverage can be a daunting task but there are websites like Medicare.gov and MedicareInteractive.org where you can learn more. The Westchester Library System also operates a volunteer senior benefits individual counseling program to help county residents explore coverage options (SBIC@wlsmail.org, 914-231-3260).
So where do supplemental benefits come into all of this? Medicare Advantage plans must provide coverage for everything that is covered under Original Medicare, but Advantage plans are free to provide additional benefits for their enrollees. These benefits can be health-related (dental, vision, hearing) or non-health-related (transportation, meals, and more). Here’s what you need to know when you see or hear advertisements for plans with these supplemental benefits:
1) Coverage of supplemental benefits is limited. A Medicare Advantage plan promising dental benefits obviously won’t cover everything – the plan rarely describes the services, procedures, and amounts they are willing to cover.
2) You may not be eligible for supplemental benefits. Some plans limit supplemental benefits to people with chronic conditions, low income, or other specific criteria.
3) Supplemental benefits are sometimes attached to riders. In some cases, you will need to pay an additional fee to add supplemental coverage to your plan.
4) Supplemental benefits may be optional or mandatory for a given Medicare Advantage plan.
With those four points in mind, it’s easy to see how two people on the same Medicare Advantage plan might have different benefits. The key takeaway from all of this is that you should be careful about accepting these extra benefits at face value; always call the private insurance company to confirm details about supplemental benefits. If you have signed up for Medicare coverage that was not what you expected or not what you need, there are opportunities to change that coverage at specific points in the year.
For help comparing your Medicare coverage options, you can always reach Westchester Library System volunteers at SBIC@wlsmail.org or 914-231-3260.