What questions should I ask before signing up for a Medicare Advantage Plan based on its supplemental benefits?

Dear Isaiah, 

Great question! It’s possible to assume that a plan’s supplemental benefits cover more than they do. For example, you might assume a plan’s dental benefit covers fillings and x-rays, when it might only cover yearly cleanings. So, it’s important to understand exactly how a plan’s supplemental benefits work before signing up for the plan. Ask the following questions to better understand the available coverage: 

• Is this really a supplemental benefit? Or is this service covered under Original Medicare? 
  • Sometimes, plan marketing materials can make it seem as though they are covering additional services when these services are actually covered by Medicare. To find out if a service is covered by Original Medicare, call 1-800-MEDICARE (1-800-633-4227) or use Medicare.gov too look up the service. 
• If I am signing up for a Medicare Advantage Plan because it has this benefit, have I also made sure that the plan’s other coverage will work for me? 
  • For example, are all my providers in this plan’s network? Are my drugs on this plan’s formulary? 
• Is this benefit offered to all enrollees in this Medicare Advantage Plan?  
  • Is it an optional benefit that I need to sign up for? 
  • Is it a benefit only offered to plan members with chronic conditions? Do I meet the plan’s criteria for coverage? 
  • Is the benefit only available in some circumstances? 
• Is there a cost associated with this benefit? 
  • Is there an additional premium? 
  • Are there copays or coinsurances for these services? 
  • Is this Medicare Advantage Plan’s premium higher than comparable plans that do not offer this benefit? 
• Are there limits to how much I can use this service? For example, a set number of rides under a transportation benefit or a dollar limit on eyeglasses? 
• Are there restrictions on where and how I can access these services? For example, do I need to see in-network providers, receive a referral, or participate in a care management program? 
• Are there some excluded services within this category of benefits? 
• Is this the most cost-effective way for me to access these services? 
  • Is a separate insurance plan or private payment an option? Do these alternatives offer more benefits? What is the difference in cost, including premiums? 

Be sure to keep records of any conversations you have with plan representatives, such as the date and time of the call, and name and contact information of the rep. Also try to get everything in writing. 

Hope this helps! 

-Marci