A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by original Medicare. These benefits 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 care
• Vision care
• Hearing aids
• Gym membership

These benefits can either be:

• Optional, meaning 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 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).

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Medicare Advantage supplemental benefits and chronic conditions: What's covered?

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 purifiers. 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.

How do I know if I am eligible for Medicare Advantage supplemental benefits?

Before signing up for a Medicare Advantage plan that includes supplemental benefits or before receiving services that are covered by these benefits, ask the following questions to better understand the available coverage:

• Is this truly 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 already covered by original Medicare, you can call 1-800-MEDICARE (1-800-633-4227).
• If I am signing up for a Medicare Advantage plan because it contains 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 that is 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 or how often 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?

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Other ways to access similar supplemental benefits

In some cases, there may be no Medicare Advantage plan in your area that covers the supplemental benefits that you need. Or you might find that original Medicare offers better coverage of services that are important to you. The following list provides some alternatives to Medicare Advantage supplemental coverage.

• Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. In some states, Medicaid covers services that are not covered by Medicare, including dental, vision, long term care, and transportation. To learn more about your state’s Medicaid program, you can contact your local State Health Assistance Program (SHIP) by calling 877-839-2675 or visiting shiphelp.org.
• Medigap plans, which are Medicare supplementary insurance, only pay secondary to original Medicare in cases where original Medicare covers a service and pays primary. But some Medigaps also offer additional days of inpatient hospital care beyond what is covered by original Medicare and/or emergency medical services received outside of the United States, which are not covered by original Medicare. Medigaps can also offer fitness benefits or other targeted supplemental coverage in some states.
• Reduced-cost or free clinics are services you may be able to access through a free or reduced-cost clinic in your area. Use resources available at NeedyMeds.org, healthcare.gov, freeclinics.com, and hhs.gov for more information
• Donated dental service programs or dental schools operate in some states. Dentists in these programs offer free dental services if you qualify. You may also be able to get low-cost dental care at a dental school, where dental students work with patients under the supervision of experienced, licensed dentists.
• Administration for Community Living (ACL) Eldercare Locator can help you learn about other resources in your community, such as long-term care and legal aid. Visit eldercare.acl.gov or call 1-800-677-1116 to learn more.

How do I use Medicare Advantage supplemental benefits?

Supplemental benefits are items or services covered by a Medicare Advantage plan that are not covered by original Medicare, such as dental, vision, or transportation. It’s important to learn as much about a plan’s supplemental benefits before enrolling in that plan or using these benefits. There might be rules on how you access these benefits, or restrictions that make the benefit more limited than you realized. If these kinds of services are important to you, but you cannot find a Medicare Advantage plan that is a good fit for you, there are alternative insurances and strategies that could help you access similar services.

Looking for additional information? Get our Frequently Asked Questions guide to MA supplemental benefits.