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Potential New Benefits May Be Coming to Some Medicare Advantage Plans

April 2018

The list of benefits covered by Medicare Advantage plans could grow to be more expansive when new federal laws take effect in 2019.

In April of 2018, the Centers for Medicare & Medicaid Services (CMS) expanded its definition of “primary health-related” benefits that private insurance companies are allowed to include in their Medicare Advantage plan offerings.

Some of the benefits that could potentially be added to the approved list include:

  • Transportation to doctor’s offices
  • Grab bars in home bathrooms
  • Healthier food options
  • Air conditioners for people with asthma
  • Home-delivered meals
  • Aides to help with daily activities like dressing or eating

The expansion of the “primary health-related” definition will include care and devices that are used to:

  • Treat or prevent injuries or illness
  • Compensate for physical impairments
  • Reduce emergency medical care
  • Address the psychological effects of injuries or illness

While any new benefits would not require a doctor’s order or prescription, they would have to be deemed “medically appropriate” and recommended by a licensed health care provider.  

Medicare Advantage Plan Benefits

By law, Medicare Advantage plans must cover everything that is covered by Original Medicare (Medicare Part A and Part B). Each plan may then also include additional benefits at their discretion. Some Medicare Advantage plans include benefits like dental, vision, hearing and prescription drug coverage, none of which are covered by Original Medicare. Some plans may even offer coverage for gym memberships and fitness programs. 

The additional benefits that are available with some Medicare Advantage plans could be one reason why over one-third of all Medicare beneficiaries are enrolled in one of the thousands of Medicare Advantage plans available nationwide.1   

Before taking effect, any benefit packages for 2019 Medicare Advantage plans must first be approved by CMS. The list of approved benefits is expected to be released in the fall of 2018, when annual open enrollment begins.  


1 https://www.kff.org/medicare/issue-brief/medicare-advantage-2019-spotlight-first-look

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