Q. I get some help in the home and transportation to doctor appointments covered by my Medicare and Medicaid plan, but my friend says her plan gives her $120 every month to buy vitamins and food. She has Medicare and Medicaid too. How can I get what she has?
A. It sounds as though both you and your friend have some form of a Medicare Advantage plan for dual eligible individuals. Being dual eligible means that you qualify for Medicaid due to having a lower income, and you are either disabled or over age 65 so you also qualify for Medicare.
There are various means through which dual eligible people can access the benefits of Medicaid and Medicare. Some people have Original Medicare, Parts A and B, with a Part D drug plan, and Medicaid coverage for what Medicare does not cover. Other people might have a Medicare Advantage plan (sometimes referred to as Part C, or MA plans) which combines Parts A and B with a drug plan. Advantage Plans set a limit on what you’ll have to pay out-of-pocket every year for covered services, but in most cases, you need to use health care providers in the plan’s network. Dual eligible individuals can also be enrolled in the MI Choice Waiver program, the Program of All-Inclusive Care for the Elderly (PACE,) or MI Health Link plans, all of which can provide additional services such as care in the home, transportation, meals, and care management.
Some Medicare Advantage plans offer coverage for things Original Medicare doesn’t cover, like fitness programs, vision, hearing and dental services, transportation for doctor visits, and discounts or credits for over-the-counter (OTC) drugs and supplements. A Medicare Advantage Special Needs Plan offers benefits and services to people with specific diseases, certain health care needs, or those on limited incomes, such as dual eligible individuals. Also known as D-SNPs, these plans often offer the additional funds or OTC / healthy food credits that can help pay for vitamins, liquid nutrition, and healthy grocery items. Some plans even allow for ordering groceries for delivery, or a limited number of home-delivered meals. This sounds like the plan that your friend has, and you likely have a different type of Advantage Plan or are part of a program through MI Choice Waiver, PACE, or MI Health Link.
As Open Enrollment for Medicare is about to start, now is a great time to evaluate your Medicare coverage to see what might work best for you in 2023. The key thing to remember is to evaluate what you currently have against what is being offered. It might sound great to have $50 to $100 each month for OTC and food costs, but are you giving up anything from your current coverage to have that benefit? For instance, if you have a paid in-home caregiver and transportation whenever it is needed for medical appointments, or treatments such as dialysis, does the new plan offer the same? Some D-SNPs have limited numbers of rides each year. Some do not offer in-home care providers and you would need to find a caregiver on your own. Some plans might require you to only use certain medical providers and your current provider might not accept that new plan. These are important cost / benefit considerations that should be made before changing to new coverage.
Remember Medicare Open Enrollment starts Oct 15th!
Remember Medicare Open Enrollment runs from October 15 to December 7, 2022. In most cases this is the only time you can pick a new Medicare Advantage or Part D plan. Area Agency on Aging and Michigan Medicare/Medicaid Assistance Program (MMAP) staff and volunteers are here to help!
Contact a certified MMAP Counselor: 1-800-803-7174; info@areaagencyonaging.org
Reminder: A community screening of The Remember Project’s In The Garden, a video production of a one act play about memory loss, takes place on Thurs Oct 6, 5:30-7:30pm at GhostLight Theatre, 101 Hinkley St in Benton Harbor. In-person and Zoom viewing options available.
Tickets are free and donations are gratefully accepted to fund additional Dementia Friendly Communities programming. Call 269-982-7748 for information.