Traditional Medicare members are not eligible for non-medical benefits

Private insurers cannot provide medical benefits to Medicare Advantage plan participants, but these are different from traditional Medicare.

That Medicare open enrollment period for 2022 is scheduled to start on October 15th and run until December 7th. Ads and commercials are already starting to feature Medicare plans, including those claiming to be Offer a $900 grocery benefit and those who say them Offer free gym memberships.

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


Are Traditional Medicare Recipients Eligible for Free Non-Medical Services?



That's wrong.

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


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

That Centers for Medicare and Medicaid Services (CMS) calls the traditional Medicare plan operated by the federal government the original Medicare plan. It covers visits to the hospital and doctor’s office. Original covers too Services to treat or diagnose a disease, including surgery that is not cosmetic in nature, and disease prevention services, including flu shots. It does not cover prescription drugs by default, but original Medicare members can supplement their coverage with a prescription drug insurance plan operated by a private insurer.

The federal government contracts with private insurers to implement Medicare Advantage plans. The federal government requires these plans to cover the same benefits 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 that the original Medicare doesn’t cover, such as: B. Fitness programs (gym membership or discounts)”, CMS says. “Plans can also cover even more services. For example, some plans provide coverage for services such as transportation to doctor’s visits, over-the-counter medications that Part D does not cover, and services that support your health and well-being.”

Included in “Services that Promote Your Health and Wellbeing” are food benefits that promote healthy meals. Original Medicare doesn’t cover groceries or grocery deliveries, it says Health Network Groupan independent marketplace for health insurance.

Several health plans include a grocery allowance in their Medicare Advantage plans, including ClearMatch Medicare, clover health and Blue Shield of California. All three point out that the benefit is only part of some plans and is exclusively available to people with certain chronic illnesses. All plans only cover healthy or nutritious foods and cannot be used for all grocery stores. According to Blue Shield, their benefit is $25 per month, which works out to about $300 per year.

That Kaiser Family Foundation (KFF), a nonprofit that specializes in health 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 offer meal services. Some of the less common Medicare Advantage benefits include transportation, acupuncture, home support services, and bathroom safety devices.

More from VERIFY: No, Medicare does not offer a free Flex card

There are many different Medicare Advantage plans, some of which may be cheaper and more beneficial to you than the original Medicare. But it depends heavily on what you need and where you live, so it’s possible that original Medicare might 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 medical conditions or serious health needs and those who live in rural areas may be better off with Original Medicare, depending on which Medicare Advantage plans are available to them.

KFF found that almost all people with Medicare Advantage plans pay less for a three-day hospital stay than people with original Medicare coverage. However, it also found that more than half of Medicare Advantage members begin paying more than original Medicare members once a hospital stay lasts seven days.

You need to research which plan is best for you and whether the added benefits of a Medicare Advantage plan will actually save you money between premiums and expenses. Your local state health insurance assistance program may be able to provide you with information and registration assistance to enable you to choose the plan that is best for you.

More from VERIFY: Medicare ads claiming to pay money back into your Social Security check need context

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Text: 202-410-8808 Traditional Medicare members are not eligible for non-medical benefits

Laura Coffey

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