Healthcare Educators


New Non-Medical Benefits for Medicare Advantage Enrollees

by | Apr 27, 2020

Good health is a complicated puzzle. It contains many pieces: genetics, environmental factors, habits and so on. While traditional health insurance benefits only address part of this puzzle, new rules let Medicare Advantage plans look at the whole picture to help enrollees manage their health. As an insurance broker, you can help your clients find the right plan with the non-medical benefits they need to live happier, healthier lives.

The Rise of Medicare Advantage

Medicare Advantage has become an increasingly popular option for seniors in recent years. According to CMS, approximately 24.4 million beneficiaries chose a Medicare Advantage plan for 2020. This is more than one-third of the total number of Medicare enrollees, and it represents a 30.6 percent increase since 2017.

There are many attractive aspects of Medicare Advantage plans. One is the price. Average monthly premiums for Medicare Advantage plans have actually been decreasing, a fact that’s especially shocking given the overall rise of healthcare costs. In 2020, the average monthly premium was only an estimated $23.00.

And for this small cost, Medicare enrollees can have access to many benefits not included in Original Medicare. This has often included hearing, dental and vision benefits, as well as many other benefits that can be essential to helping seniors maintain good health. However, these extra benefits have traditionally been limited to offerings that are medical in nature. Now, thanks to new rules, this is changing.

The Acceptance of Non-Medical Benefits

At first, it may seem odd for a health insurance to cover things like meal delivery, carpet shampooing and transportation. However, these benefits can be part of the wellness puzzle. Someone with heart disease could benefit from heart-healthy meals. Someone with asthma could breathe easier with clean carpets. Someone without a reliable form of transportation could get increased access to important services if given a ride.

All of these are examples that CMS uses to show how the new non-medical Medicare Advantage benefits could work.

According to CMS, starting in 2020, Medicare Advantage plans can offer “supplemental benefits that are not necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees. These benefits can address social determinants of health for beneficiaries with chronic disease.”

This announcement follows a rule change that allowed Medicare Advantage plans to offer in-home support services and other benefits that “diagnose, compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization” in 2019.

Getting the Services Your Clients Need

Not all Medicare Advantage plans offer these additional non-medical benefits, but many do. For the 2020 plan year, CMS has estimated that 250 plans servicing 1.2 million enrollees provide non-medical benefits like meal delivery and home environment services. In the future, more plans may embrace these additional benefits.

As plan options expand, insurance brokers may need to do a little more work.

  • Monitor the plans in your area so you know who’s offering what.
  • Talk to your clients about their chronic health conditions and difficulties.
  • Help your clients find the plans with the non-medical benefits they need most.