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Oct. 27, 2020, 3:25 p.m. EDT

How do you get the new Medicare Advantage benefits? It’s not easy

Before you sign up for one of these expanded plans, be sure you know the limits involved

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By Walecia Konrad


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New government rules have allowed Medicare Advantage plans to expand benefits to include things like meal delivery, adult day care services, bathroom safety devices and transportation.

This article is reprinted by permission from NerdWallet .

If you’re tempted by the new benefits some Medicare Advantage plans are touting, the annual open enrollment season (Oct. 15 through Dec. 7) is the time to look. But finding a plan offering the benefits might be hard.

Medicare Advantage, also known as Medicare Part C, is administered by private insurers and offers the same Medicare Part A and Part B benefits as  Original Medicare . Many plans also include limited dental, vision and hearing coverage, and even gym memberships.

Starting in 2019, new government rules have allowed Medicare Advantage plans to expand benefits even further. Commonly referred to as Special Supplemental Benefits for the Chronically Ill, or SSBCI, the new benefits can go beyond strict medical care and provide support that can help improve and prolong a sick person’s life.

Government research shows that more than 70% of seniors live with at least one chronic illness, although eligibility rules for the new benefits also require “a high risk of hospitalization or other adverse health outcomes.”

These new rules open the door to coverage for adult day care services, home-based palliative care, in-home support services, caregiver support, non-opioid pain management, memory fitness services, home and bathroom safety devices and modifications, transportation, meal delivery, pest control, over-the-counter health items, virtual health services, acupuncture and others.

Additional support for chronically ill older adults is great news. But it’s important to remember that these supplemental benefits are just that, supplemental. A provider can decide which ones, if any, to offer, and the benefits are not available to everyone in a specific plan.

See: Your guide to Medicare open enrollment: How to shop, switch, and compare plans

So far, insurers and consumers have been slow to embrace the new rules. Only an estimated 4.6% of plans are offering any new benefit, according to Brown University research published in May 2020.

Before you sign up for one of these expanded plans, be sure you know the limits involved, warns David Lipschutz, associate director/ senior policy attorney at the Center for Medicare Advocacy. Here’s what to keep in mind.

Understand what’s being offered

Benefits aren’t universally available

As part of the new rules, the government has altered what’s known as the “uniformity standard,” explains Lipschutz. Until now, Medicare Advantage plans had to offer the same benefits to all enrollees in a certain area, usually a county. So, if you’re eligible for twice-yearly dental checkups under your plan, so is everyone else enrolled in the plan.

Also read: 7 tips for saving money on prescriptions

For SSBCI benefits, however, insurers determine who qualifies. Grab bars, for instance, could be available only to patients who have already experienced a fall. Memory care may be reserved only for those patients diagnosed with a form of dementia.

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