The fastest way to find out what your Medicare Advantage plan covers is to call the Member Services number on the back of your plan ID card and ask directly. But there are three other methods that can be just as useful, and knowing all four gives you the best chance of uncovering every benefit available to you.
Method 1: Call Member Services
Calling your plan is the most direct and reliable method. The Member Services phone number is printed on the back of your Medicare Advantage ID card. Representatives are available during business hours and are required by law to answer your questions about your benefits.
When you call, be specific. Generic questions like "what does my plan cover?" will get you a generic answer. Instead, ask about each benefit by name. Here are questions worth asking on every call:
- "Do I have an OTC (over-the-counter) benefit? How much per quarter? Where can I use it?"
- "Do I have a home safety or home modification benefit? What is the annual allowance?"
- "Do I have a PERS or medical alert system benefit?"
- "Do I have a dental benefit? What does it include?"
- "Do I have a vision benefit? Does it include an allowance for glasses?"
- "Do I have a hearing benefit? Does it help pay for hearing aids?"
- "Do I have a transportation benefit for medical appointments?"
- "Do I have a fitness benefit like SilverSneakers?"
Write down the name of the representative you speak with and the date of the call. If there is ever a dispute about your benefits, having those notes can help.
Method 2: Log Into Your Member Portal
Every major Medicare Advantage plan has a member website or app. If you haven't created an account yet, it takes about 10 minutes and requires your plan ID number and a valid email address.
Once you're logged in, look for sections labeled "My Benefits," "My Plan," "Coverage Summary," or "Summary of Benefits." Many portals let you check your remaining OTC balance, view your dental and vision allowances, and even place orders from the OTC catalog directly online.
If you're not comfortable using a computer, ask a family member or caregiver to help you set up an account. Once it's created, checking balances can be done in just a few clicks.
Method 3: Review Your Summary of Benefits
Every fall, your Medicare Advantage plan mails you a document called the Summary of Benefits (SOB). This document explains every benefit your plan includes in plain language, along with any costs like copays or deductibles.
The Summary of Benefits is designed to be readable, not a legal document. If you saved your annual enrollment packet from last fall, the Summary of Benefits is usually the shorter booklet in the packet. You can also download a current copy from your plan's website or request one by calling Member Services.
Look for sections titled "Extra Benefits," "Supplemental Benefits," or "Additional Benefits" to find things like OTC allowances, home safety benefits, and dental coverage. These sections often contain the most useful and overlooked information.
Method 4: Review Your Evidence of Coverage
The Evidence of Coverage (EOC) is the full, detailed version of your plan's benefits. It is longer and more technical than the Summary of Benefits, but it contains the exact rules for every benefit, including what is and isn't covered, how to get prior authorization, and how to file a claim.
You don't need to read the entire EOC. Use the table of contents to find the specific benefit you're researching. For example, if you want to understand your DME (durable medical equipment) coverage, jump to that section and read the specific rules. The EOC is the definitive answer if there's ever a question about whether something is covered.
What to Do With What You Learn
Once you've confirmed your benefits, write them down in one place. A simple sheet of paper works well. Include the benefit name, the dollar amount or number of visits, how to use the benefit, and any deadlines. For example: "OTC benefit: $100 per quarter, use at CVS or Walmart, resets January 1, April 1, July 1, October 1."
Put this sheet somewhere easy to find, like on the refrigerator or in a binder. Review it at the start of each quarter and at the start of each year. Benefits that reset annually should be used before December 31.
Get Free Help From SHIP Counselors
If you find this process confusing or overwhelming, you don't have to do it alone. Every state has a State Health Insurance Assistance Program (SHIP) that provides free, one-on-one Medicare counseling. SHIP counselors are trained volunteers and staff who can help you understand your benefits, compare plans, and even appeal a denial.
To find your local SHIP, visit shiphelp.org or call 1-800-MEDICARE (1-800-633-4227). The service is completely free and unbiased. SHIP counselors do not sell insurance.
Tips for Staying on Top of Your Benefits
- Call early in the year, before benefits reset, so you have the whole year to use them.
- Set a reminder on your phone or calendar for the start of each quarter to check your OTC balance.
- Ask your doctor at each visit whether any new equipment or services might be covered by your plan.
- If your plan changes at the start of the year, review your new Summary of Benefits right away.