What are supplemental benefits?

A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare. Common supplemental benefits include:

• Dental Care
• Hearing Aids
• Gym Membership
• Vision Care

Supplemental benefits can be:

• Optional: They are offered to everyone enrolled in the plan. You can choose to purchase coverage if you want. For example, an optional dental benefit for which you can pay an extra premium.
• Mandatory: They are covered for everyone enrolled in the plan. For example, a gym membership benefit that’s included in the plan. You don’t pay an extra premium, and you can’t decline or opt out of the benefit. Mandatory doesn’t mean you need to use it, though.

Supplemental benefits must be primarily health related. There are some exceptions, though, for people with chronic conditions. See the following section for more.

Medicare Advantage Supplemental Benefits: Supplemental benefits for chronic conditions

Plans can cover supplemental benefits that are not primarily health-related for enrollees 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 someone’s life that can affect their health in some way. Examples of the kind of benefit that plans can cover are:

• Meal delivery
• Transportation for non-medical needs
• Home air cleaners
• Pest remediation
• Heart-healthy food or produce

To be eligible, you must be chronically ill. If you meet the criteria, a Medicare Advantage Plan may offer you one of these benefits.

Note that not every member of a 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 its members who have serious asthma. A member of that plan who doesn’t have asthma, or whose asthma is not as severe, will not have access to this coverage.

Questions to ask a Medicare Advantage Plan

You might be interested in a plan that offers these supplemental benefits. If so, learn as much as possible before enrolling in the plan. It’s important to know exactly how a plan’s supplemental benefits work before signing up. Make sure to document calls and get information in writing. Ask questions like:

• Is this an optional benefit that I need to sign up for? Do I need to pay extra for it?
• Is the benefit only for people with chronic conditions? If so, do I meet the criteria?
• Are there limits to how much I can use this benefit?
• Are there restrictions on where and how I can access these services? For example, do I need to see in-network providers or get a referral first?
• Is this the most cost-effective way for me to access these services?
• Do the other parts of this plan’s coverage (not just the supplemental benefits) work for me? Are my providers in the plan’s network? Does the plan cover my drugs?