Be cautious when shopping for Medicare insurance.
The Medicare Advantage Open Enrollment Period, from January 1 through March 31, brings with it many, many commercials. These focus on the low cost and benefits one can get simply by calling the phone number on the screen. Enrollment couldn’t be easier. However, a smart shopper will realize there is much more to know about a plan before enrolling, especially about “the benefits you deserve.” Here is how you can become that smart shopper.
Dental and vision benefits
Original Medicare does not cover dental services, except for procedures that are an integral part of a covered service, such as reconstruction of a jaw following an accident. Medicare may also pay for oral examinations but not treatments preceding a kidney transplant or heart valve replacement.
Medicare Advantage plans must cover those same services, and then many plans go beyond that and offer coverage for routine dental care. This includes preventive services like cleanings, x-rays, and oral examinations; and comprehensive services, such as fillings, extractions, and dentures.
Just as with dental care, Original Medicare does not cover routine vision services – exams, refraction, glasses and contact lenses – but many Advantage plans do. Both Original Medicare and Medicare Advantage cover medically necessary vision care for those with glaucoma, macular degeneration or cataracts.
If you’re checking out dental or vision benefits in an Advantage plan, start with the Medicare Plan Finder. On the page listing available plans, you’ll see green checkmarks next to plans that offer these services. Click on the details for a plan, scroll down to “Extra benefits & costs,” and you’ll find services covered, your cost and any prior authorization (“Advanced Plan Approval Required”) or limits that apply. Most plans do place limits on the coverage, but the specifics are not noted in the Plan Finder.
You have to check a plan’s Evidence of Coverage to learn more. To get to that document, scroll to the bottom of the details page and click on “View plan website.” You’ll likely have to do some detective work to locate that document but, once you do, you’ll get the information you need. Here are two examples:
- A 5-star, zero-premium HMO (health maintenance organization) plan in the Midwest has a $300 limit for routine dental services at participating providers. This plan also offers an optional comprehensive dental package with $1,000 reimbursement for an additional premium of $48 a month.
- A zero-premium PPO (preferred provider organization) plan in the Southeast covers one vision exam and $150 of non-Medicare covered eyewear in a year at any licensed vison provider who will see Medicare patients. These costs do not apply to the plan’s out-of-pocket maximum.
Enrollees generally must submit documentation to get reimbursement for the services and each plan has its own procedure.
Additional benefits
The commercials tell us that plans offer meals, transportation, private home aides, bathroom safety devices, and more. Medicare does not cover these supplemental healthcare benefits for “daily maintenance,” those that are not necessarily health-related but can help beneficiaries with overall function and management of the effects of chronic disease. Recent policy changes allow Medicare Advantage plans to offer them.
Here are some points the commercials don’t tell you.
- Not every Medicare Advantage plan offers these benefits.
- Plans can choose to offer coverage for one or more of these benefits.
- The offerings are limited. In every plan I have reviewed (which is a small sample), an enrollee could pick one benefit for the year.
- There are limits on the benefit. In the 5-star HMO, an enrollee can choose transportation, which is 60 one-way trips in a calendar year, scheduled 48 hours in advance with the approved vendor, for health-related services only (no grocery shopping or personal errands). Another option is in-home aide services for assistance with activities of daily living (ADL) and home-based chores, limited to no more than four hours in a day for a maximum of 31 days in a year.
To get the details on these benefits, once again, start with the Plan Finder and then study the Evidence of Coverage.
Tried and true advice for choosing a Medicare Advantage plan
- Do not pick a plan simply for the additional benefits it offers.
- Confirm that the plan covers your medications, pharmacies, and physicians, that it will be as cost-effective as possible, and has acceptable quality scores.
- After narrowing down your choices, check out the additional benefits
- Then, instead of calling the number on the screen, contact the plan directly. You’ll find the phone number on the plan details page or you can click on the green “Enroll” button that appears on three different pages in the Plan Finder.
Be a smart shopper. Get past the advertisements to the details before it’s too late.
