A supplemental benefit is an item or service covered by a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan that is not covered by Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. . These benefits do not need to be provided by Medicare providers or at Medicare-certified Medicare-certified means offering services at a level of quality approved by Medicare. Medicare will not pay for services received from a health care provider that is not Medicare-certified. facilities. Instead, to receive these items or services, you need to follow your plan’s rules. Some commonly offered supplemental benefits are dental care, vision care, hearing aids, and gym memberships.
Most supplemental benefits must be primarily health-related. These benefits can either be:
- Optional, meaning that they are offered to everyone who is enrolled in a plan, and you can choose to purchase the benefits if you want to, or
- Mandatory, meaning that they are covered for everyone enrolled in a plan and you cannot decline the coverage (even if you do not need to use the service).
Supplemental benefits for chronic conditions
Medicare Advantage Plans can also cover supplemental benefits that are not primarily health-related for beneficiaries who have chronic illnesses. 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. Plans can offer benefits that are not primarily health-related like meal delivery, transportation for non-medical needs, and home air cleaners. In order to be eligible for these benefits, you must be chronically ill. To be considered chronically ill for the purpose of accessing these benefits, your plan must determine that you meet all of the following:
- 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
Since Medicare Advantage Plans will be able to create sets of supplemental benefits for people with specific chronic illnesses, not every member of a Medicare Advantage Plan will have access to the same set of benefits. 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.