Medicare Advantage Benefits That Go Beyond Basic Health Services
Medicare Advantage plans (also known as Part C or MA plans) cover all the benefits of Original Medicare (Part A and Part B). You may not know that many MA plans also offer additional benefits that Original Medicare does not — including prescription drug coverage, and vision, hearing, and dental care.
On top of this, there may be cool perks to keep you healthy, such as a gym membership. With increased competition and plans on the market, insurers are offering other, more unusual benefits, too — such as acupuncture and meal delivery.
Medicare Advantage plans can provide more benefits because the government spends more per enrollee than in Original Medicare. The extra government funding adds up to an average of $480 more per individual. Read on to find out what MA benefits you could be missing out on.
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Cost Savings, Coordinated Care, and Simplified Administration
Medicare Advantage may be a better option for some people for several reasons. These include:
- Cost savings: MA plans can offer lower monthly premiums — down to $0 — and out-of-pocket costs compared to Original Medicare.
- Coordinated care: Medicare Advantage plans typically involve healthcare provider networks coordinating your care. This coordination ensures you receive appropriate care and avoid unnecessary services.
- Simplified administration: You generally only need to deal with one insurer for all your healthcare needs — including vision and dental — so tracking your benefits and costs is easier.
In contrast, with an Original Medicare plan, you’ll need to shop for and add drug coverage, and then perhaps a Medigap plan to cover remaining “gaps.” This could work for someone who wants healthcare ala carte. However, for some people, it may be time-consuming to research, expensive if multiple premiums are involved, and inefficient to coordinate throughout the year.
Annual Out-of-Pocket Maximum
Out-of-pocket costs are your expenses not reimbursed by Medicare and typically include your deductible (what you pay before Medicare kicks in) and copays and coinsurance (your portion of a health visit or service).
The maximum is the most you’ll pay for covered services. After you hit the dollar amount, you do not pay anything else. Medicare Advantage plans may have in-network-only maximums and maximums for in- and out-of-network care.
Medicare Advantage plans have an annual out-of-pocket maximum, which can help protect you from unexpected healthcare costs. These maximums vary based on the plan, but in 2022 the average out-of-pocket maximum was $4,972. Your plan costs could be lower or higher, depending on your network or where you live.
Vision, Hearing, and Dental
Vision, hearing, and dental coverage are among the most common Medicare Advantage perks available. Vision is the most common, followed by hearing and dental. Vision services often include exams, frames, eyeglasses, or contact lenses. Hearing coverage can include exams and hearing aids.
Extra benefits vary widely by insurer and plan, so you’ll need to review the plan details carefully. For example, dental coverage could only cover simple preventive services like cleanings. Or it could pay for dentures, fillings, crowns, and other dental needs. You may need to go to an in-network provider, and plans could cap its spending on covered services.
Fitness program benefits are almost universally offered by Medicare Advantage plans.
These programs most frequently include:
- A gym membership
- On-demand fitness classes
- SilverSneakers Membership
- At-home fitness kits
Typically, you do not pay anything extra to use these services or for the memberships, as it’s included in your monthly premium.
A SilverSneakers membership benefit is one of the more widely-provided MA plan opportunities. SilverSneakers is specifically designed for older adults and includes in-person and virtual classes to boost balance, flexibility, and mental wellness. Some Medicare Advantage plans offer access to Fitness+ in concert with SilverSneakers.
Meal and Grocery Delivery Services
Meal and grocery delivery services aren’t as widely available as the perks above, but 71% of firms do offer these services. A frequent bonus consists of home-delivered meals after inpatient hospitalization or a stay at a skilled nursing facility (SNF). The benefit can last a few weeks or almost a month, but limits may apply regarding how many times you can use the perk. Meals are often ready-to-heat and tailored to needs and preferences — whether vegetarian, Kosher, heart-healthy, low sodium, or diabetes-friendly.
Those who are dual-eligible for Medicare and Medicaid or Special Need Plans (SNPs) may be able to access a prepaid Medicare flex card to buy food. Some MA plans also offer a monthly spending alliance for healthy groceries, but you might need to get approval or your doctor’s assistance.
Individuals with chronic illnesses may also qualify for a daily meal delivery program for a month or more. Meal preparation assistance may also be included in some MA plans offering personal care services from a professional caregiver.
Around 39% of MA plan providers offer transportation benefits. Most transportation benefits involve a ride to your doctor for a checkup or a pharmacy to pick up a prescription. You may be able to use an app to order your ride.
Trips may be limited to a certain number of one-way journeys or by miles per trip. Other plans might not specify required trip purposes but could restrict you to a list of plan-approved locations.
Some SNP or dual-eligible plans’ monthly spending allowances could cover non-medical transportation, too, including through ridesharing services or taxis.
Adult Day Care
Adult daycare gives caregivers a break while providing mental and social stimulation. They may also be called CBAS (Community-Based Adult Services). Services can include the following:
- Professional and therapeutic services
- Social services
These programs will most likely be covered under a Medicare Advantage plan for dual-enrollees who qualify for a special-needs Medicare-Medicaid plan due to a health condition or lower income.
However, more adult daycare services are usually found through an alternative government program called the Program of All-Inclusive Care for the Elderly (PACE). PACE is typically intended for those who would otherwise go to a nursing home. As a result, PACE covers adult day primary care, meals, and transportation to PACE centers, among other benefits.
A clean home can make breathing easier for people with special needs or chronic conditions, such as asthma. Clean air, carpets, and surfaces reduce lung irritants and allergens.
Home air cleaners could include temporary or portable air conditioning units, humidifiers, or dehumidifiers. But this is not a widespread benefit, only available to about 8% of those in special-needs plans (SNPs).
Other clean home perks to make your living space more comfortable could include the following:
- Furnace filters
- Space heaters
- Cleaning supplies
- Carpet cleaning
- Pest control
These may be covered by monthly allowances on spending cards.
Other Surprising Perks
Other surprising Medicare Advantage benefits that may not be as widespread include:
- Integrative Medicine: Including acupuncture, massage, chiropractic, and naturopathic services
- Bathroom Safety Devices: An annual allowance to spend on devices
- Telemonitoring: A personal monitoring device and emergency response service
- Caregiver Support: One-on-one coaching and personalized resources
- Home Modifications: Annual allowance could include grab bars, aids for reaching, or temporary wheelchair ramps
- International Emergency Coverage: Emergency services if you’re abroad
Optional Supplemental Benefits and Your Medicare Advantage Plan
Beneficiaries may benefit from a Medicare Advantage plan with additional perks. These perks can improve your overall health by providing basic dental, vision, and hearing services — as well as equipment, fitness services, meal delivery services, transportation, and more.
Reach out to your Medicare Advantage plan provider to see if there are benefits you aren’t using but qualify for — or if you need to do anything to qualify for the perks. If not, it may be time to consider switching to a plan with more benefits. Doing so could save you money and keep you healthy as you age.