Tv commercials

The Truth About Those Medicare Advantage TV Ads

Through Richard Eisenberg, Next avenue Editor

Chances are you’ve seen those Medicare Advantage TV commercials featuring William Shatner, George Foreman, Jimmie Walker and Joe Namath touting “free” health insurance plans offering attractive benefits not available in the so-called “Original Medicare” (also called “Traditional Medicare”). But are they real?

Now that it’s Medicare open enrollment season through Dec. 7, if you’re 65 or older and are eligible for Medicare, or a loved one is, you’ll want to know the answer.

My “Friends Talk Money” podcast co-hosts and I just took a look at the popular Benefit of Medicare plans (also called Medicare Part C plans) for our latest episode, speaking with Medicare specialist Diane Omdahl of 65Incorporated.com. These plans, now chosen by 42% of Medicare beneficiaries, are sold by private health insurers, as opposed to the alternative Original Medicare program offered by the federal government.

The ads, said “Friends Talk Money” co-host Terry Savage, a syndicated personal finance columnist and author and health insurance expert, promote their one-stop shop and potential money savings.

What the Medicare Advantage Ads Say

Savage noted that ads often say, “Let us do it all! And we’ll give you hearing. [coverage] and we’ll give you dental care and we’ll pick you up and drive you to your doctor’s appointments. We’re getting you a turkey for Thanksgiving! They promise so much.”

Omdahl told listeners, “Based on the ads that are shown on TV every day, people see something that they think is more profitable, and then they go for it. [Medicare Advantage] a blanket without really knowing what they’re getting into.”

She’s right. A recent Kaiser Family Foundation survey found that seven in 10 Medicare beneficiaries did not compare coverage options during the last open enrollment period. And in a MedicareAdvantage.com survey of more than 1,000 beneficiaries, three out of four called Medicare “confusing and difficult to understand.”

According to the Kaiser Family Foundation, the average Medicare beneficiary has a choice of 54 Medicare plans, there are 766 Medicare Part D prescription drug plans, and a record 3,834 Medicare Advantage plans will be available in 2022 (up 8% compared to 2021).

Here’s the gist of Omdahl and the “Friends Talk Money” hosts: Some of what you hear on those Medicare Advantage TV commercials is true, but the fine print shows that “free” isn’t really “free.” When the ads say “zero premium, zero deductible and zero co-pay”, that’s not the whole story.

Before explaining the truth about Medicare Advantage costs and coverage, it may be helpful to provide some background on Open Enrollment and Medicare Advantage plans. (Buckle up: Medicare’s open enrollment rules are complicated.)

During annual open enrollment, Medicare enrollees can switch from Original Medicare to Medicare Advantage or vice versa; switch between Medicare Advantage plans and enroll in a Medicare Part D prescription drug plan in some cases.

There is also an open enrollment period for Medicare Advantage, from January 1 through March 31, when you can switch your Advantage plan to another or switch back to Original Medicare and enroll in a Part D plan.

The Fine Print of Medicare Advantage Plans

Medicare Advantage plans, usually associated with prescription drug coverage, usually require you to use health care providers in their network. Policies limit your annual out-of-pocket costs for covered services.

“People need to look beyond the ads” to understand the fine print of Medicare Advantage plans, Omdahl said. “There are indeed zero-premium Advantage plans and a lot of the plans don’t have [annual out-of-pocket] franchises. But the zero co-payment is misleading. The zero co-pay is for your attending physician; Depending on where you live, co-pays may apply in other situations.”

Plus, Omdahl notes, “start digging into the evidence of coverage and you’ll see that Medicare Advantage is pay-as-you-go: fifty dollars to see a specialist, four hundred dollars a day for five or six days of hospitalization.” you write checks, and that’s what people don’t realize. They think “zero premium” means it’s free, which it doesn’t. »

Savage said that due to Medicare program rules, Medicare Advantage enrollees could end up paying out of pocket up to $7,500 a year; more than $11,000 per year if you use out-of-network healthcare providers.

“These plans work best if you don’t get sick,” she said. “Once you need to see a lot of specialists, you start paying.”

Omdahl said that before you enroll in a Medicare Advantage plan, understand that any time you want non-emergency care, the plan must approve it.

“If you need physical therapy, for example, the plan has to approve the service request, then they’ll usually say the person gets three visits or five visits or whatever. So they control the use of the member’s services . ,” she explained.

Savage said if you’re in a Medicare Advantage plan and want to switch back to traditional Medicare for 2022, you might run into a problem. “If you have fallen ill, there is medical underwriting [a health care provider must check you out before you’re granted coverage] and in most states they can deny you the most comprehensive Medicare supplement [Medigap] plan.”

Think before you change

So, Savage advised, “think very carefully before you leave traditional health insurance, which allows you to see just about any doctor or go to any hospital.”

I noted a recent study by the nonprofit health care research group The Commonwealth Fund that looked at Medicare Advantage plans and traditional health insurance. The overwhelming majority of Medicare beneficiaries in both Traditional Medicare and Medicare Advantage programs were satisfied with their care.

Researchers found that Advantage plans didn’t significantly improve beneficiaries’ healthcare experiences over traditional health insurance, but offered a bit more care management.

This means that those enrolled in Medicare Advantage were more likely to have a treatment plan where someone would review their prescriptions for them and deal with medical issues relatively quickly. “By providing this additional help, Medicare Advantage plans make it easier for enrollees to get the help they need to manage their health conditions,” the study said.

Among those with a health condition, a greater share of Medicare Advantage enrollees in the study said a healthcare professional gave them clear instructions about symptoms to watch out for and discussed their priorities in treatment. disease management.

Where to get help from Medicare

“Friends Talk Money” co-host Pam Krueger, founder of the Wealthramp Financial Advisor Verification Program, says “a great fiduciary and paid financial planner can make sure you get the comparisons you need.” during open Medicare enrollment.

Three other useful resources for Medicare Open Enrollment purchases (in addition to 65Incorporated): the Medicare.gov site, the eHealth Medicare site, and the State Health Insurance Assistance Programs site known as SHIP .

“There’s no right or wrong” when it comes to choosing between traditional Medicare and Medicare Advantage plans, Savage said. “As long as you’re well informed about these health insurance decisions, you’ll be in great shape for 2022.”