When Pam O’Neill underwent a total knee replacement, her Medicare Advantage plan picked up nearly all the costs. But one aspect of her coverage surprised her.
“I get $250 per quarter to spend on a flex card,” says O’Neill, 73, who lives in Wayland, Massachusetts. “That’s a lot of money, but I can’t use it for a lot of things.”
She was hoping to use those funds, which expire at the end of each quarter, to cover the cost of a walker to help with her recovery from surgery. Her plan’s flex spending card, however, only covers basic health care products, like bandages, Tylenol, Q-tips and bunion pads, not walkers.
Medicare flex cards can be an enticing option for some beneficiaries, but others — like O’Neill — might find that this benefit falls short of what it promises. Here’s everything you need to know about these debit cards, including how they work, what you can use them for and whether they’re right for you.
[READ: Medicare vs. Medicare Advantage: How to Choose.]
What Is the Medicare Flex Card for Seniors?
Medicare flex cards, a fairly recent addition to the Medicare benefits universe, cover certain health-related services and products. They are not issued by the federal government and are not part of original Medicare, which consists of Part A and Part B.
Rather, these cards are made available to enrollees by some insurance companies sponsoring Medicare Advantage plans, explains Bob Rees, chief sales officer with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
Benefits are provided on a prepaid plastic card, similar to a credit card, that is separate from your Medicare Advantage health insurance card and other Medicare-related cards. These cards may go by different names depending on the plan, and not all Medicare Advantage plans offer them.
[READ: Worst Medicare Advantage Plans: How to Find a Good One]
How Medicare Flex Cards Work
Typically, flex cards come in the form of prepaid debit cards with a specific dollar amount allotted per year, like O’Neill’s $1,000 issued in quarterly payments.
There are usually two ways benefits tied to these cards are structured:
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You should also keep in mind:
— The dollar amount and what’s covered vary from plan to plan.
— Benefits don’t roll over from one year to the next and may expire quarterly if they’re incremental payments. If you don’t use all of the benefits, you’ll forfeit that money.
— Not all retailers and health care professionals accept payments via Medicare flex cards. Your plan will typically provide you with a list of places where you can use this benefit.
What a Medicare Flex Card Can Be Used For
Generally speaking, Rees says that you may be able to use a flex card to pay for health and wellness-related items, such as:
— Glasses
— Some nonmedical transportation
— Insurance copayments
In some cases, groceries, cell phone bills and even service dog support may be included as covered items, while other plans may limit use of your flex card to certain retailers. It all depends on the specifics of the Medicare Advantage plan you’re enrolled in.
O’Neill notes that the plan provider issues a list of items that are included in the flex card spending benefit, but “it’s so complicated to use” because many things she would expect to be on the list — like walkers — simply aren’t.
[READ: Medicare Advantage HMOs vs. PPOs: Which Is Right for You?]
Medicare Flex Cards vs. Health Allowance Cards
Some Medicare Advantage plans refer to their flex card programs as a health allowance card or spending account card. Some also use the term Medicare spending card. No matter what name they go by, these prepaid debit cards are effectively all the same as a Medicare flex card.
If your plan includes this perk, the card will be preloaded with a set dollar amount on a regular basis — monthly, quarterly or annually — and you can use it to purchase certain health-related items.
Who Qualifies for the Medicare Flex Card?
Seniors who are enrolled in a qualifying Medicare Advantage plan may be eligible to get a Medicare flex card. Each plan sets its own eligibility rules, and not every enrollee will be qualified for a Medicare flex card.
Some plans restrict these cards to individuals with chronic conditions.
How to Get a Medicare Flex Card
To get a Medicare flex card, you’ll need to enroll in a Medicare Advantage plan that offers one.
“You can review the different Medicare Advantage plans available in your area during Medicare’s annual enrollment period in the fall or at other times of year if you qualify for a special enrollment period,” Rees says.
How to Know If a Medicare Flex Card Is Right for You
Some seniors love these cards and find them a valuable benefit, Rees says. He cautions, though, that you shouldn’t let the possibility of having one sway you toward one health insurance plan over another.
“We hear from a lot of Medicare beneficiaries looking for flex cards,” he explains. “Their enthusiasm is understandable, especially for anyone living on a tight budget. However, it’s important to note that picking the right Medicare plan for you should involve a holistic review of your personal health needs and what you can afford in terms of premiums and out-of-pocket costs.”
If the right plan for you does include a Medicare flex card, Rees recommends that you also make sure the plan covers the prescription drugs, doctors and hospitals you require.
Select a Medicare Plan That Meets All Your Needs
As you’re assessing different plans, make sure you understand all the specifics before you enroll because each plan has its own quirks and variations. You can also work with a licensed agent or contact your local State Health Insurance Assistance Program for help.
“The hardest thing when you go on Medicare is picking out a plan because they all act like they’re pretty much the same, but it’s really complicated for people to figure out which one they want,” O’Neill says.
You should also take a moment to consider whether your health needs are likely to change during the plan year. It’s impossible to know what the future will bring, but if you’re generally healthy, a Medicare Advantage plan might be a good choice, as these often have lower premium costs than original Medicare plans.
However, if you have one or more chronic health conditions or are at high risk of developing one, you may be better off with an original Medicare plan paired with a Medicare supplement plan that doesn’t require prior authorization and may have a lower deductible.
And no flex card can bridge that gap.
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What Is a Medicare Flex Card? originally appeared on usnews.com
Update 03/11/26: This story was published at an earlier date and has been updated with new information
