Feb 11, 2020,10:41am EST
Diane Omdahl Contributor Retirement
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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