How MA flex cards can squeeze seniors
Add Axios as your preferred source to
see more of our stories on Google.

The popular debit cards that Medicare Advantage plans give older adults as a perk for signing up may be cutting off their access to some public assistance because of conflicting interpretations on what counts as income.
Why it matters: The "flex cards" are becoming more common in plans targeted to disabled and low-income older adults, according to an analysis from ATI Advisory shared with Axios. Almost half of all Medicare Advantage plans will feature the cards next year.
- Medicare advocates and members of Congress are pressing the Biden administration to clarify that such supplemental benefits shouldn't be considered income as the Medicare open enrollment period continues.
How it works: Medicare Advantage plans heavily market the debit cards, which can be used for groceries, utility payments or extra medical equipment such as walkers. The dollar amounts and restrictions on what they can be used for vary by plan, and the cards have sometimes been marketed in misleading ways.
- In 2025, the average standard flex card benefit will be $996 for the year, per ATI Advisory.
State of play: The hitch, according to seniors and aging services providers, is that flex cards are being counted as income in eligibility determinations for some other benefits and limiting older adults' ability to tap rental assistance or Supplemental Security Income.
- The IRS generally excludes payments from social welfare programs from recipients' gross income.
- But every agency that offers assistance programs has its own rules and restrictions around what counts as income.
- Most Medicare Advantage benefits are excluded from a renter's income when applying for assistance from the Housing and Urban Development Department, but the law requires some benefits that can be used toward utilities and rent to count as income, a HUD spokesperson told Axios.
