You’ve seen television commercials where you’re urged to call an 800 number to find out about the extra benefits that come with a Medicare Advantage plan.
You may be under the impression these extra benefits are unlimited and never cost money. This is not true. Let’s look at a some extra benefits that typically come with Medicare Advantage plans.
Vision: Most plans provide a routine eye exam at no charge. They will also provide an allowance to help pay for lenses, frames, or contacts. Let’s say the allowance is $300.00. If your lenses, frames or contacts cost more than $300.00 you pay the difference. Some plans offer an optional supplement, with a monthly premium, for enhanced coverage.
Hearing: Most plans provide a routine hearing exam at no charge. Some plans provide an allowance for two hearing devices. Similar to vision coverage, if your hearing aids cost more than the allowance, you pay the difference. Other plans charge a copay. Let’s say your plan comes with a $900 copay for one advanced hearing aid or $1,800 for two. This is all you will pay. Plans use certain third party vendors at these prices. If you want hearing aids from another company, you will typically pay more.
Grocery Benefit: A frequent question from beneficiaries is whether their plan has a grocery benefit. The grocery benefit is typically available for people who receive Medicaid along with Medicare. Some insurance companies offer a grocery benefit for those who can attest to a chronic medical condition. Conditions include, but are not limited to, diabetes, cardiovascular disorders, pulmonary disorders, and disabling mental health conditions. Verification from a doctor is needed. If you do not receive Medicaid, and do not have a chronic medical condition, the grocery benefit is not available.
Transportation: Some insurance companies provide routine transportation, at no cost, to approved locations such as a doctor’s office. You get a certain number of trips per year. You will typically find mile limits on how far the third party vendor will travel to pick you up and drive you to a location. Ambulance is not part of this benefit.
Dental: Insurance companies provide an allowance for dental coverage. Once the allowance is exhausted, you are on your own. Procedures covered by the insurance company varies. For example, some plans cover preventive procedures such as clearnings. Nothing else. Other plans will pay for preventive and comprehensive procedures. Depending on the plan, some procedures are omitted such as implants. A plan may attach copays and coinsurance charges. Some plans offer enhanced dental coverage with a monthly premium.
Some Medicare Advantage plans offer additional money (a flex allowance) for vision, hearing, dental and other benefits such as routine podiatry. Check your Summary of Benefits to see if your plan has such an allowance.
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If you have questions about the extra benefits on your plan, please call 725-227-6795, send an email to [email protected], or fill out contact form on this website. I am a licensed insurance broker.
