If you watched any television in the last several
months, you probably saw a slew of commercials for Medicare Advantage plans.
One that pops up frequently features a former professional football player who
once did a commercial wearing pantyhose. His commercials must be working so
well that another former NFL star has also started promoting Advantage
plans.
All the commercials, no matter the narrator,
talk about the Medicare benefits you deserve, that you should be getting. They
list those benefits in a very big and bold font, and encourage you to call the
free number and sign up today.
According to Federal law, whatever we see
or hear in an advertisement must be truthful and not misleading. I spent some
time the last few days closely watching several different commercials.
Everything that was said about the cost and benefits was true, to the extent
that it was said. But there was much left unsaid and that’s the important
information you need to make a smart decision.
First, the benefits
Get the benefits you deserve, including rides
to medical appointments, private home aides, nurse and doctor visits by
telephone.
Medicare describes these as benefits for daily maintenance and
doesn’t cover them. However, because of policy changes, Medicare Advantage
plans can now provide them. The plan, not Medicare, must cover the costs. This
is a new program and not that many plans offer these benefits.
Based on my preliminary plan research, here
are some important points not mentioned in the commercials:
·
These benefits appear
to be more common in health maintenance organization (HMO) plans. Except
for an emergency, the benefits are only available through a network of selected
providers, which can limit the individual’s choice.
·
The plan likely will
require prior approval or authorization. Before
receiving care, the plan must review and approve the physician’s order.
·
There are limits on
these benefits. For example, two meals a day for five days after
hospitalization with a limit of four hospitalizations, and a private home aide
four hours a day for no more than 31 days in a year.
·
And, most important,
the plans we researched require members to select only one benefit per calendar
year.
In some of the commercials, there were two
more benefits that require clarification.
Free preventive screenings
Medicare covers a long list of preventive and screening services. You don’t
need to enroll in one of these plans to get preventive services.
A 75% discount on prescription medications in
the Coverage Gap
You see this and think, “Wow! A big discount
on drugs! Where do I sign?” However, as with preventive services, this benefit
is not unique to Medicare Advantage plans.
The Coverage Gap is more commonly known as the
donut hole. In 2020, the donut hole closed. Beneficiaries are
responsible for 25% of the cost of medications in this payment stage. Or, in
other words, they get a 75% discount. Anyone with Part D prescription drug
coverage will qualify automatically for this discount when their total drug
costs hit $4,080. This benefit comes with the plans in the commercials, some
other Advantage plan with drug coverage, or a stand-alone Part D drug
plan.
Second, the costs
All these benefits may be available at no
additional cost to you.
The commercials focus on zero-premium plans
and benefits available for no added cost. However, at the moment the narrator
says this, a line of small type appears on the bottom of the screen. It’s there
for only four seconds, while the list of benefits continues. The small type
reads, “Plan premiums, copayments, and coinsurance can apply.”
Not all Medicare Advantage plans are
zero-premium. And for those that are, it’s important to know that zero-premium
does not mean zero costs. There are out-of-pocket costs for most services. Plan
members will pay their share of costs until they reach the plan’s out-of-pocket maximum limit. That’s how much a
person could write in checks when something happens, like a cancer diagnosis or
a major car crash. In 2019, the average limit was $5,059.
Third, the call
The narrators talk about the help you will get
when you call the toll-free number. But, once again, the small print is revealing.
Dial the number and you’ll be transferred to a
licensed insurance agent. One commercial noted that the agent may or may not
offer Medicare Advantage plans. Another said the person you talk with may not
offer plans in your area.
A question
The facts, as presented, are true but then the
question becomes, “Are these commercials misleading?” According to the Macmillan dictionary, misleading means
something that is intended or likely to make someone believe something that is
incorrect or not true.
In fall 2019, the American Medical Association (AMA) passed a resolution.
“Whereas, Medicare Advantage plans are heavily
marketed to seniors by insurance companies, with less than ideal transparency
in advertising; … and
“Whereas, Presentations by insurance company officials
to seniors can overemphasize the value of different options and can create
confusion; therefore be it
“RESOLVED, That our American Medical
Association encourage AARP, insurance companies and other vested parties to
develop simplified tools and guidelines for comparing and contrasting Medicare
Advantage plans.”
The AMA identified the need for tools to help
individuals go beyond the TV commercials and get the information they need to
make a smart decision.
The Centers for Medicare and Medicaid Services
redid its tool for comparing plans. The Medicare Plan Finder shows the premium in
a large font. Then, you can check out the plan’s out-of-pocket costs for
medical benefits on the details page. Beyond that, as pointed out in a past post, most of the essential information
has disappeared. The Plan Finder no longer has links to networks, a list of
preferred pharmacies, and most important, complete information about coverage
rules like prior authorization.
The best way to get all the facts is to check
the plan’s Evidence of Coverage. This document describes in detail the plan’s
benefits, how much you will pay, and how the plan works, including
authorization rules, limits, networks, and more. To find it, go to the plan’s
website, look for the Evidence of Coverage link. This may take some searching
but you’ll get the information you need on available benefits, limits,
approval, and more.
Keep in mind that these Medicare Advantage
plans are offered by for-profit entities, corporations not unlike your cable
provider, department store, or neighborhood used car lot. The purpose of the TV
commercials is to get you to act, to call the number on your screen, to make a
purchase. First, do your research. Be an informed shopper. Go beyond the
commercials to the whole truth. Your Medicare coverage is too important
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