Private insurers can offer non-medical benefits to enrollees of Medicare Advantage plans, but those are different than traditional Medicare.
The Medicare open enrollment period for 2022 is due to begin on Oct. 15, and will run through Dec. 7. Ads and commercials are already beginning to publicize Medicare plans, including those that claim to offer a $900 grocery benefit and those that say they offer free gym memberships.
A number of VERIFY readers have emailed and texted VERIFY to ask if these benefits are real. Joyce, for example, asked, “Are Medicare recipients eligible for $900.00 in grocery benefits?”
THE QUESTION
Are traditional Medicare recipients eligible for free, non-medical benefits?
THE SOURCES
Centers for Medicare and Medicaid Services (CMS)
Health Network Group, an independent health insurance marketplace
Health insurance companies including ClearMatch Medicare, Clover Health and Blue Shield of California
Consumer Reports, a nonprofit consumer advocacy organization
Kaiser Family Foundation (KFF), a nonprofit organization that focuses on healthcare research
THE ANSWER
No, traditional Medicare recipients are not eligible for free, non-medical benefits. These are part of Medicare Advantage plans run by private companies.
WHAT WE FOUND
Various non-medical benefits are offered by private Medicare Advantage plans, which differ from the standard original Medicare plan offered by the federal government.
The Centers for Medicare and Medicaid Services (CMS) calls the traditional Medicare plan, which is the basic plan run by the federal government, original Medicare. It covers visits to the hospital and doctor’s office. Original also covers services to treat or diagnose a medical condition, including surgeries that aren’t cosmetic, and services meant to prevent illness, including flu shots. It doesn’t cover prescription drugs by default, but original Medicare enrollees can supplement their coverage with a prescription drug coverage plan run by a private insurer.
The federal government contracts with private insurers to run Medicare Advantage plans. The federal government requires these plans to cover the same services as original Medicare — with a few exceptions like clinical trials and hospice care — and allows these plans to provide additional coverage or benefits.
“With a Medicare Advantage Plan, you may have coverage for things original Medicare doesn’t cover, like fitness programs (gym memberships or discounts),” CMS says. “Plans can also cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs that Part D doesn’t cover, and services that promote your health and wellness.”
Included in “services that promote your health and wellness” are grocery benefits that promote healthy meals. Original Medicare doesn’t cover groceries or grocery delivery, says Health Network Group, an independent health insurance marketplace.
Several health insurance companies include a grocery benefit in their Medicare Advantage plans, including ClearMatch Medicare, Clover Health and Blue Shield of California. All three note the benefit is part of only some plans, and is available strictly to people with certain chronic illnesses. All of the plans only cover healthy or nutritious foods, and cannot be used for all grocery store items. Blue Shield says their benefit is $25 a month, which is equal to about $300 a year.
The Kaiser Family Foundation (KFF), a nonprofit organization specializing in healthcare research, says 98% of individual Medicare Advantage plans include fitness benefits, which would include gym memberships. KFF found that 71% of individual Medicare Advantage plans provide meal benefits. Less common Medicare Advantage benefits include transportation, acupuncture, in-home support services and bathroom safety devices.
More from VERIFY: No, Medicare is not offering a free flex card
There are many different Medicare Advantage plans, some of which may be cheaper and more beneficial to you than original Medicare. But it’s highly dependent on what you need and where you live, and so it’s possible original Medicare may be more cost effective for you instead.
Consumer Reports, a nonprofit consumer advocacy organization, says Medicare Advantage plans are typically good for healthy adults in urban and suburban areas. But people with chronic conditions or severe health needs, and people who live in rural areas, may be better off with Original Medicare depending on what Medicare Advantage plans are available to them.
KFF found that nearly all people on Medicare Advantage plans pay less for a three day hospital stay than people on original Medicare. But it also found that more than half of Medicare Advantage enrollees begin to pay more than original Medicare enrollees once a hospital stay lasts as long as seven days.
You have to research which plan works best for you, and whether the extra benefits of a Medicare Advantage plan will actually save you money between premiums and out-of-pocket costs. Your local state health insurance assistance program may be able to provide you with information and enrollment assistance to help you pick the plan best for you.