| Dear Marci, I am making decisions about Medicare coverage options, and one of my friends told me that I should ask the plans that I’m considering whether they have any supplemental benefits. What are supplemental benefits? -Emmy (Houston, TX) Dear Emmy, A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare. These items or services do not need to be provided by Medicare providers or at 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 careVision careHearing aidsGym membership For the most part, supplemental benefits must be primarily health-related. Beginning in 2020, however, Medicare Advantage Plans can begin covering supplemental benefits that are not primarily health-related for beneficiaries who have chronic illnesses. These benefits can address social determinants of health for people with chronic disease. A social determinant of health is a part of your life that can affect your health in some way, such as not having access to transportation. Examples of the kind of benefits that plans can now cover are: Meal deliveryTransportation for non-medical needsHome air cleanersPest remediationHeart-healthy food or produce In order to be eligible for this new category of supplemental benefits, you must be considered chronically ill. This means that you: Have at least one medically complex chronic condition that is life-threatening or significantly limits your health or functionMedically complex chronic conditions include cardiovascular disorders, diabetes, chronic lung disorders, neurologic disorders, chronic heart failure, chronic and disabling mental health conditions, cancer, dementia, chronic alcohol or drug dependence, autoimmune disorders, stroke, end-stage renal disease (ESRD), severe hematologic disorders, end-stage liver disease, and HIV/AIDS.Have a high risk of hospitalization or other negative health outcomes, andRequire intensive care coordination If you meet the above criteria, a Medicare Advantage Plan may offer you one of these new benefits if it has a reasonable expectation of improving or maintaining your health or function. 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 to its members who have asthma. A member of that plan who has asthma may be able to get these services covered, while a member who does not have asthma may not. Before enrolling in a Medicare Advantage Plan that has these new supplemental benefits, check if you meet the plan’s criteria for coverage. Contact your plan to find out how to access these and other supplemental benefits. -Marci |