MEDICARE ALLOWANCE EXPLAINED: WHAT YOU NEED TO KNOW

Medicare is a federal health insurance program. Take the time to explore your options; you may get some extra benefits from your Medicare Advantage plan. Some programs even provide food, fitness and other perks to eligible members.

You probably have seen television commercials featuring celebrities like Joe Namath and William Shatner touting Medicare Advantage plans, also called Medicare Part C. According to the Kaiser Family Foundation, these plans are chosen by 48% of Medicare beneficiaries.

One reason these plans are so popular is that they offer a variety of allowances, from food and groceries to transportation and wellness programs. However, "there are limits on the allowances," notes Diane Omdahl, president and co-founder of the Medicare consulting firm 65 Incorporated and author of “Medicare for You: A Smart Person’s Guide.”

Medicare Grocery Allowances

Some Medicare Advantage plans offer a grocery allowance. With these, you usually get a card to pay for "healthy" foods such as fruits and vegetables, frozen meals, fresh salad kits, dairy products, water and soup. You can’t use your card for things like alcohol, sugary and processed foods or pet food.

This allowance amount doesn’t roll over from month to month, so you need to use all of it in that month, or you will lose it. It is also important to note that you may not be able to use your card at all stores, so you need to find out where to shop with this allowance. Your plan can provide you with a list of eligible stores. At the same time, some plans will enable you to use your card for things like home-delivered meals, such as after surgery or a hospital stay.

Grocery allowances are most commonly offered with Medicare Special Needs plans. To qualify, you likely will need to undertake an annual wellness visit, complete a health risk assessment and provide documentation of a specific condition.

Medicare Wellness Programs

Wellness programs were among the earliest perks offered by Medicare Advantage plans. “These were initially designed to promote enrollment,” says Omdahl. Perhaps the most recognizable is the SilverSneakers program, which allows Medicare Advantage members to choose a participating fitness center and enjoy equipment and classes. They also sometimes provide at-home workout kits.

Many Medicare Advantage plans also offer some coverage for dental care, eyewear and hearing aids. However, Omdahl suggests not counting on coverage for all of these expenses. Find out what is covered and what limitations are involved before you join a plan, and be aware that these benefits can change from year to year.

Other Options

Some plans offer other allowances. For instance, some may cover nonemergency transportation. This usually includes travel to and from a doctor’s office and some plans even cover Uber or Lyft trips to and from other venues, such as fitness centers.

Medicare Advantage plans can choose to provide health maintenance benefits, which can include meals, transportation, private home aides, bathroom safety devices.

Before signing up for any plan, you should get more information about your potential home health care needs. Ask questions such as:

How many visits are covered and over what time period?
What copay will you be expected to pay?

Telehealth is a Medicare benefit so you can get it even if not in a Medicare Advantage plan. However, the Medicare Advantage plans can offer a wider range of telehealth benefits, including the option for telemedicine visits with specialists. Again, this offering varies from plan to plan, so knowing what you’re getting is crucial before you join a plan.

How Do I Get These Allowances?

You need a Medicare Advantage plan to get these allowances. Medicare Advantage plans are administered through a private Medicare-approved insurance company, funded by the federal government and provides an alternative way to receive your original Medicare benefits.

Do Your Homework

Each Medicare allowance has different criteria and requirements, so it's important to do your research and understand precisely what each covers.

You can find ratings of Medicare Advantage plans from the National Committee for Quality Assurance. You can also get help via phone or in person from your State Health Insurance Assistance Programs. Those agencies often maintain office hours at senior centers or other locations.

2023-04-18T13:59:02Z dg43tfdfdgfd