Extra benefits to look for in a Medicare Advantage plan

Patrice King Brown: Whether you’re new to Medicare, exploring your options, or just want to keep up with the latest in Medicare news, we’ve got you covered.

Stacy Smith: No fluff, no jargon. Just real conversations to help you navigate Medicare with confidence. I’m Stacy Smith.

Patrice King Brown: And I’m Patrice King Brown. Welcome to “Medicare for the Record,” brought to you by UPMC for Life.

Stacy Smith: Welcome to this episode of “Medicare for the Record.” We have a special guest with us today and that is Katie Rombach. She is the director, program management for Medicare at UPMC Health Plan. We're going to discuss some of the extra benefits offered by Medicare Advantage plans and how to determine which plan offers the benefits that you really need. Katie, thanks for joining us. Tell us a little bit about yourself.

Katie Rombach: Yeah, thank you so much for having me. I've been with UPMC for about 10 years. I've worked on both our hospital side and the insurance side, so I'm really familiar with a lot of the services that we offer to the community, and I'm excited to be a part of a team that brings those services to those that need it the most.

Patrice King Brown: Well, you know what, Katie, many Medicare Advantage plans offer extra benefits, and I think some people are unaware of that. So what kinds of services fall into that category?

Katie Rombach: Yeah, there's a plethora of options. So things like dental, vision, hearing, transportation services to your doctor appointments, travel coverage, over-the-counter allowances to spend on things like Tylenol, band-aids, things you might need in your day-to-day life, gym memberships. The list really goes on. So there's a lot of options that are available that aren't covered by your traditional Medicare.

Patrice King Brown: Are there any benefits that are a little less known than others?

Katie Rombach: Yeah, there are some. So things like healthy food and utility allowances can really help populations that meet low income levels or chronic conditions. Also, personal emergency response devices, caregiver support—so things that can really help the people that are helping you. And it's important to know that not every member would be eligible for every single one of those benefits. So when you're researching, it's really important to understand which ones you would qualify for.

Stacy Smith: So there are several different plans, several different kinds of benefits that could be offered. And so you take a look at them, you're talking about dental and you're talking about vision and transportation and gym memberships. So how really valuable are these benefits for the person who's trying to choose a plan, just some sort of nice perk or can they really be beneficial?

Katie Rombach: Yeah, they're definitely a perk, but they really do have the ability to impact your health outcomes or out-of-pocket costs. So if you think about something like a home safety device—so an example would be like a grab bar in your shower, something like that may seem small, but it can help prevent a fall. It can keep you out of an inpatient hospital stay or a surgery and it can help you stay in your home longer and stay healthy. So there's things like that that when you're researching Medicare Advantage, it's really important to think not only what do you need now, but what are you going to need long term.

Stacy Smith: So when you're talking about all these sort of things, what should people really be looking for when they're trying to choose a plan?

Katie Rombach: So first and foremost, you want to make sure that your medical and pharmaceutical coverage is appropriate for your needs. So is your dentist in network? Is your PCP covered? Things like that so that there are no surprises from an out-of-pocket cost standpoint there. Then you can look into some of those extra benefits. So I would really encourage people to think about their lifestyle and what are some of those extra things they're hearing about that they feel like they would truly need because a lot of them sound great, but are you going to use them? And so you want to make sure you're selecting the plans that have the best advantages within the things you're actually going to use.

So an example of that would be over-the-counter allowances. Depending on the insurer, not all of those are the same. So the allowance could be different. The things that you could buy might be different, the method for buying them; can you go to the store or do you have to order online? And so when you're researching different items, it's really important to understand, again, what do you need and how can the plan meet you where you are.

Patrice King Brown: So Katie, how can consumers compare the extra benefits from Medicare Advantage plans?

Katie Rombach: Yeah, really good question. So there's a few different options. If you're interested in comparing on your own online, you can visit medicare.gov, which is the official Medicare website. That will bring up plans in your area and you can look at them side by side. There's also some state health insurance assistance programs that will be an unbiased look at health insurance plans in your area at no cost to you. And you can access that information by calling 1-800-MEDICARE. You can also call any insurance provider in your area, and they would be more than happy to walk you through their various plans and which one would fit your needs.

Stacy Smith: Let's talk a moment if we can, for some of these benefits. You brought up like somebody needing a grab bar in the shower. How does that work if I'm there and it's obviously I need something like that, how does the Medicare Advantage plan work to help like that?

Katie Rombach: Things like home safety devices can be accessed in a variety of ways depending on the plan. At UPMC specifically, we offer you a card with an allowance on it and you can choose personally how you're going to spend that allowance. You would go online or look in our catalog and you would figure out which of those items is best for you. Maybe it's a grab bar or maybe it's something else that's better suited in your home. And then for things like gym memberships, we have a few different ways that members can access these, which are really great. You can access a network of facilities via our SilverSneakers® benefit, which may be a fitness location that you're already using or is in your community. And then we also have some premier fitness locations where you could do like an Orange Theory class or a Pure Barre class, something a little out of the ordinary if you're interested.

Stacy Smith: All right, so let's talk more for a moment if we can about the dental and the vision. Are those ones that are preferred doctors you should go to?

Katie Rombach: So we do have in-network providers that you can see for dental, vision, and hearing. We have a couple different options for you when looking at dental, vision, hearing benefits, we have more of what you consider your traditional coverage. So you're going to the dentist, you're getting your routine checkups, those types of items. We also have a flex card option that gives you an allowance on a lot of our plans that you can spend on extra items. So maybe they're not covered under the traditional dental, vision, hearing benefit that we have, but you want to get a new pair of prescription glasses or you want to get a particular dental procedure that you can use that allowance to cover some of your out-of-pocket costs. So that's really how some of these extra benefits help you bring those out-of-pocket costs down.

Patrice King Brown: And you mentioned too, for some plans for people who may be lower income, that there are also options for buying healthy foods.

Katie Rombach: Yeah, it's a really great benefit for our members that either meet a chronic condition or a low-income requirement. And so not only do they get healthy food allowances, but also some dollars to use towards their utilities. So it keeps people healthier, it helps their health outcomes, and it helps keep people in their homes.

Patrice King Brown: When you mentioned the utilities, somebody who might be on oxygen might need a boost for their electricity payment or something is that they could use it that way?

Katie Rombach: Yeah, so more of your traditional utilities: trash, sewage, electricity, water. And it's important when you're looking into those types of benefits to make sure you would qualify. So there's certain low-income or chronic condition requirements that most plans have. And so you want to make sure you're doing your research.

Patrice King Brown: Once again, Stacy, there's so much information, but we thank you for joining us with this. Where can we find more information? Because to compare things is great to have an idea how to look at one and look at the other and say, yeah, that works for me, or that, doesn’t.

Katie Rombach: Yeah, so there's a variety of online resources that you can use the official Medicare webpage, for example. Or you can also call a UPMC for Life resource and they'll be able to help walk you through the available plans.

Stacy Smith: Sounds great. Katie, thank you so much for joining us.

Katie Rombach: Yeah, of course.

Stacy Smith: And as we leave you with this particular episode, a couple of things you should remember, that is, extra benefits can help add more value to your Medicare Advantage plan. Most plans offer many extras that can help you stay healthy and also maintain your independence.

Patrice King Brown: And remember that while these benefits seem very appealing, it is important to look closely at what's being offered and what you need. Just because a plan offers a benefit doesn't mean that the members are getting real value from it.

Stacy Smith: Yeah. Don't purchase a plan just for its extra benefits. Make sure that your core health care needs are covered first. This, of course, would include such things as the premium cost, participating providers, prescription coverage, and other out-of-pocket expenses. And once you know those items are taken care of, then you can take a look at the extra benefits for help.

Patrice King Brown: Thanks so much for joining us and thank you for joining us for this episode of “Medicare for the Record.” This is the final episode in the series, but we want to make you aware that all episodes will be available on the website. We hope you've enjoyed it. Thank you.

Stacy Smith: Thanks.

Thanks for tuning in to “Medicare for the Record,” brought to you by UPMC for Life. To learn more about your Medicare options, visit upmchealthplan.com/fortherecord.

This podcast is provided for general informational and educational purposes only. It is not medical care or advice. For questions regarding medical care, please consult with your health care provider. Views and opinions expressed by the participants are solely their own and do not necessarily reflect those of UPMC Health Plan, its subsidiaries, parents, or affiliates.

All allowance amounts are based on the 2026 benefit year. Other eligibility and coverage criteria may apply, and having the listed chronic conditions does not guarantee that you meet the requirements.

Certain benefits are part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program. To be eligible, you must qualify for Low-Income Subsidy (LIS) and have one of the following chronic illnesses: chronic/disabling mental health conditions, metabolic disorders, cardiovascular disorders, substance use disorders, diabetes, or other eligible conditions not listed. Eligibility for this benefit cannot be guaranteed based solely on your condition. All applicable eligibility requirements must be met before the benefit is provided. For details, please contact us.

UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.

 

 

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