Nothing is more important than knowing your health insurance will be there for you when you need it.
When choosing a health care plan, you expect to access doctors, specialists, hospitals, emergency rooms and testing when needed. If that plan is with Medicare Advantage, you can check before signing up to be sure your favorite doctors and hospitals are on the plan's in-network list. If not, you will have to pay out-of-pocket expenses related to using that doctor or facility.
Takeaway action step: Check costs and exactly what each plan offers – including if your medications are covered – at Medicare's website. Once you have made your choice, contact your preferred doctors to be sure they accept the plan. Then sign up.
Considering the popularity of these plans offered by private insurance companies, it is vital to know that some in the Medicare Advantage community have resorted to marketing through television ads before and during the Open Enrollment Period (October 15 through December 7) – and some of the practices are deceiving. Those same claims also appear in the oversized postcards and letters you receive in your mailbox.
Who is concerned about Medicare Advantage offers on tv?
Two groups, in particular, are concerned that Medicare beneficiaries may be misinformed or confused about what is being offered: the U.S. Senate Committee of Finance and the U.S. Centers for Medicare & Medicaid.
The Senate committee has released a new report about the unacceptable increase in marketing materials and tactics designed to trick seniors. The marketers' goal is to push seniors to sign up for the company's plans, and their tactics include:
Deceptive mail advertisements.
Misleading claims about increasing your Social Security benefits.
Aggressive in-person marketing tactics.
Enrolling beneficiaries in a new plan without consent (especially those dually eligible for Medicare and Medicaid).
The U.S. Centers for Medicare & Medicaid Services (CMS) recently issued a memo entitled "CMS Monitoring Activities and Best Practices during the Annual Election Period." This memo voices CMS's concern about the marketing practices of all entities involved. It has notified Medicare Advantage organizations, and Part D sponsors that they are responsible for what their agents, brokers and other contracted third-party entities say.
CMS is particularly concerned about national television ads that:
Promote Medicare Advantage plan benefits and cost savings available only in limited areas and to limited enrollees.
Overstate the available benefits.
Use words and imagery that may lead beneficiaries to believe the ad comes directly from the government.
For example, one deceptive ad says beneficiaries will get money back in Social Security checks, although this claim applies to only a small number of people in specific zip codes.
Others advertise the "extra benefits" that include rides to the doctor, dental coverage, hearing aids and home meals. But after enrolling, the plan holder may learn that only a small portion of those costs are covered, their preferred providers won't accept the plan or service providers are inconveniently located.
And even other marketers promote appealing plans without premiums, deductibles or copayments. Many of these ads cover large geographic areas, so those who enroll may find no providers in their county, making the plan unusable.
What will change to protect beneficiaries?
Starting on January 1, 2023, CMS requires all television ads to be submitted for review and prior approval. Existing materials must be reviewed to determine if they meet CMS requirements, and if not, they must be discontinued immediately. And if plans continue to use CMS-disapproved ads, they will be subjected to compliance actions.
Here is CMS's plan of action, starting immediately during the 2022 Open Enrollment Period for 2023 coverage:
Enhancing the review of existing marketing materials.
Reviewing all marketing complaints received during this enrollment period.
Reviewing recordings of agent and broker calls with beneficiaries seeking coverage.
Doing "secret shopping" of marketing events, calling advertised phone numbers and testing online tools.
Requiring all agents, brokers and third-party marketers to record and keep all their calls with prospects throughout the enrollment process.
Until changes are made, how do you protect yourself?
Whether you are seeking a replacement for an existing Medicare Advantage plan or switching from the government's Original Medicare during the Open Enrollment Period (October 15 through December 7), here are some actions to take to increase the odds of finding a good plan and avoiding disappointment:
Check with friends and family for the names of trusted insurance agents or insurance providers who have provided reliable service for several years. Referrals can be your best resource.
Find an online resource that educates you about your Medicare options through articles, videos and access to a dialog, so you know what is true and what is not.
If you feel rushed by a marketer, consider it a red flag. Enrollment does not take 20 minutes but rather several hours to identify drug history, preferred pharmacies, use of mail order, health status, possible travel and financial limits, among other details. If the agent did not do that, do not sign up for that plan.
Be very cautious if you are calling a helpline advertised on television.
Do not assume that an offer is valid because it is promoted by a celebrity you know and trust. Celebrities are paid to read a script and to get you to call a number.
Be wary of ads that insist you act quickly or a marketer who calls you repeatedly.
If researching online or opening an email, be careful what you click. If you recognize the company's name, you are safer finding their phone number online and calling them directly. If you don't recognize the name, think twice before considering them.
If you think you've been enrolled in a plan that isn't what was promised or doesn't work for you, call 1-800-MEDICARE (1-800-633-4227) for help.
If the plan you enrolled in makes you uncomfortable, remember that you have the Medicare Advantage Open Enrollment Period between January 1 and March 31 to change a Medicare Advantage plan or return to Original Medicare. After that, you will have to wait until next year's Open Enrollment Period in the fall.