Medicare’s open enrollment period is set to begin Oct. 15, and will end on Dec. 7.
Each year, during the lead-up to the open enrollment period, VERIFY readers send us questions about ads they see that claim to offer non-medical benefits in Medicare plans. Many of these questions are about grocery cards in particular.
Joyce, for example, asked, “Are Medicare recipients eligible for $900.00 in grocery benefits?”
THE QUESTION
Does traditional Medicare offer grocery cards and other non-medical benefits?
THE SOURCES
- Centers for Medicare and Medicaid Services (CMS)
- Health Network Group, an independent health insurance marketplace
- ClearMatch Medicare, a Medicare plan marketplace
- KFF, a health policy organization
THE ANSWER
No, traditional Medicare does not offer grocery cards or other non-medical benefits. Those 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. These plans must cover “all medically necessary services” covered by original Medicare, but may use their own criteria to determine medical necessity. The costs of these plans vary, and they may limit an enrollee’s choice in doctor, but can offer extra benefits not covered by original Medicare, CMS says.
“With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings),” a CMS booklet says.
Original Medicare doesn’t cover groceries or grocery delivery, says Health Network Group, an independent health insurance marketplace. But CMS says Medicare Advantage plans may cover groceries to help ensure enrollees’ unmet medical needs and nutrition needs are met.
Some, but not all, Medicare Advantage plans offer meal delivery or grocery benefits as part of their plan, according to ClearMatch Medicare, a Medicare plan marketplace. A plan’s grocery benefit may offer enrollees a monthly, quarterly or annual allowance for eligible food and grocery items. Most of these plans will send enrollees a grocery benefits card that can be used at checkout to pay for the eligible items.
Typically, only healthy foods are eligible for coverage and not all grocery stores will qualify for coverage, ClearMatch says. While qualification for enrollees will vary from plan to plan, ClearMatch says that enrollees typically must have a qualifying health condition to be eligible for a grocery benefit.
Some health conditions that may qualify an enrollee for a grocery benefit include cancer, heart disease or heart failure, diabetes, kidney disease, end-stage renal disease (ESRD), obesity, arthritis and autoimmune disorders, ClearMatch says.
The KFF, a health policy organization, says 95% of individual Medicare Advantage plans include fitness benefits, which would include gym memberships. KFF found that 74% of individual Medicare Advantage plans provide meal benefits. Less common Medicare Advantage benefits include transportation, acupuncture, in-home support services and bathroom safety devices.
There are many different Medicare Advantage plans, some of which may be cheaper and more beneficial than original Medicare for some enrollees. But it’s highly dependent on what the enrollee needs and where they live, so it’s possible original Medicare may be the more cost effective option for other enrollees.
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.