What Are Medicare Advantage Supplemental Benefits?

As a senior in or approaching retirement, you may be looking at your medical care options. Original Medicare has been the traditional route seniors go through to get medical coverage. Did you know other options may be a better fit for your lifestyle and medical needs?

Medicare Advantage plans bundle the features you find in traditional Medicare with some you don’t. These plans often cost less while expanding your healthcare options. What are Medicare Advantage Supplemental Benefits? 

Understanding Medicare Advantage Supplemental Benefits

Medicare Advantage Supplemental Benefit plans provide various benefits under one health plan. You get in-patient and outpatient medical services and coverage for prescription drugs, vision, dental and hearing services. Although you can obtain medical care and hospitalization under Medicare Parts A and B, you pay extra for supplemental benefits like prescription drug coverage.

Medicare Advantage plans generally cost less than traditional Medicare but often have limited provider networks. 

How Do Medicare Advantage Supplemental Benefits Differ From Traditional Medicare?

Individuals 65 or older can get traditional Medicare or Medicare Advantage coverage. While both plans provide medical and hospitalization insurance, they differ in cost, benefits and providers.

Traditional Medicare

Traditional Medicare is government-funded medical insurance for people 65 years and older. Medicare covers in-patient hospital services through Part A and outpatient medical care through Part B.

Traditional Medicare insurance doesn’t include coverage for prescriptions, hearing, dental or vision services. However, you can add supplementary plans for extra coverage. Medicare Part D offers prescription drug coverage. Medicare supplement plans, known as Medigap, provide additional coverage.

Medicare Advantage

Private insurance companies offer Medicare Advantage (Part C) coverage. Like traditional Medicare plans, these plans cover in-patient hospital care and outpatient medical services. Medicare Advantage plans offer expanded benefits, such as prescription drug coverage and hearing, dental, vision and fitness services. Instead of having multiple policies as you would under traditional Medicare, Medicare Advantage plans offer coverage in one plan.

Medicare Advantage coverage costs less than traditional Medicare. Plus, Medicare Advantage has more built-in benefits you might have to pay for under traditional Medicare.

However, provider choice is more restrictive under Medicare Advantage plans. You typically need a referral to see a specialist. Medicare Advantage normally requires you to stay local for medical care. You may encounter difficulties getting care if you frequently travel outside your network.

Traditional Medicare coverage is nationwide. You can get medical care in any state if the provider accepts Medicare. 

Types of Supplemental Benefits

Medicare Advantage plans give flexibility to tailor your policy to meet your medical needs better. 

Optional

Medicare Advantage plans typically offer dental, vision, hearing and prescription drug coverage. However, you can expand some of these options for an additional premium. While you may have vision coverage under your current plan, you can add an optional benefit to increase the eyewear coverage limit. Some Medicare Advantage plans include optional benefits, such as acupuncture, chiropractic services, in-home support and home modification. 

Mandatory

Mandatory supplemental benefits (MSBs) are medical services included in the Medicare Advantage plan. Enrollees must accept or purchase MSBs as part of their policy. MSBs may consist of prescription, dental or vision coverage. 

Supplemental Benefits for Chronic Conditions

Additional benefits offered to members with chronic illnesses may be offered to help maintain or improve health. Examples include transportation to medical appointments, home-delivered meals, pest control, social needs benefits or other services to help manage conditions.

Factors to Consider When Getting Medicare Advantage Supplemental Benefits

Individuals with extensive medical conditions or special needs may qualify to enroll in a Special Needs Program (SNP). A Medicare SNP offers the same services as you have under Medicare Advantage. However, SNPs come with extra services based on your healthcare needs.

You may qualify for a Chronic Condition Special Needs Plan (C-SNP) if you suffer from a chronic condition, such as cancer, type 2 diabetes or lung disease or have a substance use disorder. With a C-SNP, you get additional benefits targeted toward your condition, such as an allowance for extra hospital days or a case manager to help coordinate your care. 

Eligibility

You qualify for Medicare Advantage if you live in the United States and have enrolled in Medicare Parts A and B. To be eligible for Medicare Advantage, you must reside in the service area your plan covers. In addition, you must apply during the prescribed enrollment periods. 

Suits Your Needs

Before choosing Medicare Advantage, evaluate the plan’s benefits against your medical needs. A Medicare Advantage plan may be a good fit if you need dental, vision, hearing or prescription drug coverage. If you have chronic conditions, you may get better care through a Medicare Advantage C-SNP plan than with Original Medicare. 

Costs

Medicare Advantage plans generally cost less than Medicare Parts A and B. Plus, Medicare Advantage plans have an out-of-pocket limit on what you pay, whereas Original Medicare policies don't.

While Medical Advantage typically has lower premiums, you often pay deductibles, copays or coinsurance. These out-of-pocket expenses won’t be a big deal if you rarely see a doctor. But if you visit the doctor or need medical care regularly, this can get costly, even with an out-of-pocket maximum.

Even though you may experience the same cost constraints under Original Medicare, you can purchase a Medigap supplemental policy to defray these costs. Medicare Advantage doesn't offer this feature. 

How and Where These Benefits Apply 

Medicare Advantage plans are available in five types:

• HMO: Health Maintenance Organization
• PPO: Preferred Provider Organization
• MSA: Medicare Savings Account
• PFFS: Private Fee-for-Service Plan
• SNP: Special Needs Plan

HMOs typically have lower premiums, but the provider network often limits your ability to seek medical care. You usually need a referral to see a specialist.

With PPOs and PFFS plans, you can see providers outside your network more flexibly and usually won't need referrals. However, premiums for these plans are typically higher than what you'll pay for an HMO. MSA plans offer similar features without the premium.

Benefits for a SNP fall somewhere in the middle as some services require referrals, whereas others do not.

Limits to the Benefits’ Usage

Despite its easy enrollment, Medicare Advantage plans aren’t for everyone. Healthcare services are limited to your network, so you may have difficulty getting medical care if you travel outside the state or county.

Many plans require a referral to see a specialist. Since many plans have a narrow network of providers and hospitals, you may be unable to visit your doctor. The plan's network may be so narrow that you have to go out of network for medical care.

Alternatives to Medicare Advantage Plans

Alternative ways to get medical coverage once you reach 65 years include:

Medicaid

Medicaid programs provide health coverage to low-income individuals. Medicaid plans follow federal guidelines, but the state administers the programs. Individuals qualify for Medicaid if they fall below the federal income and asset thresholds.

If you are a low-income senior, you may be able to get coverage under Medicare and Medicaid. Sometimes, Medicaid can help seniors pay for Medicare premiums and out-of-pocket expenses. Medicaid may also cover expanded services, such as skilled nursing facilities, prescriptions and hearing aids that original Medicare doesn't cover. 

Medicare Supplement Plans

Benefits under Medicare Parts A and B are limited to outpatient and in-patient medical services. You can purchase a Medicare Supplement plan if you want coverage for medication, dental care, vision or hearing services. Commonly referred to as Medigap plans, these policies can also help cover deductibles, copays and coinsurance payments. 

Stand-Alone Plans

If you prefer a stand-alone plan, you can purchase one through the ACA Marketplace. Remember that once you turn 65, you are no longer eligible for the premium subsidy. 

Flexible and Budget-Friendly: Medicare Advantage Plans 

Medicare Advantage plans offer seniors medical care at affordable prices. These plans bundle in-patient and outpatient healthcare services with other benefits, like prescription drug coverage and dental services. You can build a healthcare plan that fits your medical needs with added extras. 

Frequently Asked Questions