No, traditional health insurance does not include non-medical benefits like grocery cards or gym memberships – InsuranceNewsNet

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The 2022 Medicare Open Enrollment Period is scheduled to begin on October 15and will cross December 7. Ads and advertisements are already beginning to publicize health insurance plans, including those that claim to offer a $900 grocery store perks and those who say they offer free gym memberships.

A number of VERIFY readers have emailed and texted VERIFY asking if these benefits are real. Joyce, for example, asked, “Are Medicare beneficiaries eligible for $900.00 in the benefits of groceries? »

THE QUESTION

Are traditional Medicare beneficiaries entitled to free non-medical benefits?

THE SOURCES

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Medicare and Medicaid Service Centers (CMS)

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Health Network Groupan independent marketplace for health insurance

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Health insurance companies, including ClearMatch Medicare, Clover Health and California Blue Shield

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Consumer Reports, a non-profit consumer advocacy organization

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Kaiser Family Foundation (KFF), a non-profit organization that focuses on health research

THE ANSWER

No, traditional Medicare beneficiaries are not eligible for free non-medical benefits. These are part of Medicare Advantage plans operated by private companies.

WHAT WE FOUND

Various non-medical benefits are offered by private Medicare Advantage plans, which differ from the standard initial Medicare plan offered by the federal government.

The Medicare and Medicaid Service Centers (CMS) calls the traditional Medicare plan, which is the basic plan run by the federal government, original Medicare. It covers hospital and doctor’s office visits. Original also covers services to treat or diagnose a medical condition, including non-cosmetic surgeries, and services to prevent disease, including flu shots. It does not cover prescription drugs by default, but original Medicare enrollees can supplement their coverage with a prescription drug coverage plan managed by a private insurer.

The federal government contracts with private insurers to administer Medicare Advantage plans. The federal government requires these plans to cover the same services as the original health insurance — with some exceptions like clinical trials and palliative care — and allows these plans to provide additional coverage or benefits.

“With a Medicare Advantage plan, you can have coverage for things that original Medicare doesn’t cover, like fitness programs (gym memberships or discounts),” CMS says. “Plans may also cover even more benefits. For example, some plans may provide coverage for services such as transportation for doctor visits, over-the-counter medications that Part D does not cover, and services that promote your health and well-being.

“Services that promote your health and well-being” include grocery benefits that promote healthy meals. Original Medicare does not cover groceries or grocery delivery, says Health Network Groupan independent health insurance market.

Several health insurance companies include a grocery benefit in their Medicare Advantage plans, including ClearMatch Medicare, Clover Health and California Blue Shield. All three note that the benefit is only part of certain schemes and is only available to people with certain chronic conditions. All plans only cover healthy or nutritious foods and cannot be used for all grocery items. blue shield says their advantage is $25 one month, which equates to approximately $300 a year.

The Kaiser Family Foundation (KFF), a nonprofit that specializes in health care 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, home support services, and bathroom safety devices.

There are many different Medicare Advantage plans, some of which may be cheaper and more beneficial to you than original Medicare. But it highly depends on what you need and where you live, so original health insurance may be more cost-effective for you.

Consumer Reports, a nonprofit consumer advocacy organization, says Medicare Advantage plans are generally good for healthy adults in urban and suburban areas. But people with chronic conditions or serious health needs, and people who live in rural areas, may be better off with Original Medicare depending on the Medicare Advantage plans available to them.

KFF found that almost everyone on Medicare Advantage plans pays less for a three-day hospital stay than people on Original Medicare. But it also found that more than half of Medicare Advantage enrollees start paying more than original Medicare enrollees once a hospital stay lasts up to seven days.

You need to research which plan is right for you and whether the added benefits of a Medicare Advantage plan will actually save you money between premiums and out-of-pocket costs. Your local health insurance assistance program may be able to provide information and enrollment assistance to help you choose the plan that’s right for you.

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Richard V. Johnson