Misleading Medicare Advantage Ads: What to Watch For

Consider a change

Dear Consider,

Be wary of Medicare Advantage ads on television, radio, social media and through the mail. Although many of these advertisements tout free vision, hearing, dental and other benefits with no monthly premium, they are not always what they claim to be.

Advantage Basics

Medicare Advantage or MA plans (also known as Medicare Part C) are government-approved health plans sold by private insurance companies that you can choose in place of original Medicare. The vast majority of Advantage plans are managed care policies such as HMOs or PPOs that require you to get your care within a network of doctors in a geographic area. You can sign up for any of them during the open enrollment season from October 15 to December 7.

MA plans have exploded in popularity in recent years as insurers have flooded the airways with advertisements, often by famous personalities, that promote low-cost options with many added benefits.

But be aware that the federal government has deemed many claims in MA advertisements fraudulent and misleading. Some advertisements imply that the Centers for Medicare and Medicaid Services endorses or prefers a specific plan. Others promise bigger savings than you actually get. And if you choose the wrong plan, your doctor might not be a member of that plan network, or you might end up paying out of pocket for medically necessary care.

Last September, the U.S. Department of Health and Human Services began cracking down on these ads, but you still need to practice self-defense. Here are some tips to help you make a good decision.

Cover your needs: When evaluating MA plans, make sure the ones you’re considering cover the doctors you like and the health care facilities you usually visit. Also make sure any prescription medications you take are listed on your drug plan formulary.

To help you compare plans, a good first step is to call the practice managers of the doctors you use and find out which Advantage plans they accept and which ones they recommend. Then go to the Medicare Plan Finder at Medicare.gov/plan-compare to compare plans in your area.

Understand the details: Some MA plans offer no monthly premium, but the reality is that you are still responsible for your upfront Medicare costs, including your Part B premium, deductibles, and co-pays for covered services. Additionally, you may have to pay more if you see an out-of-network doctor. Additionally, if the plan is an HMO, it generally does not cover out-of-network non-urgent care, so an individual may be responsible for the entire cost. In contrast, a PPO allows users to go out of network, but they typically have to pay more to do so.

Do some research: Many MA plans offer free vision, hearing and dental benefits that aren’t covered by traditional Medicare, but these benefits are often limited. For example, a plan offering free dental coverage may only cover cleanings and x-rays. Extensive procedures such as root canals or caps may not be covered, or the plan may limit the amount it pays. Find out the details of the coverage so you won’t be surprised later.

Get help: Contact your local Health Insurance Assistance Program (SHIP) at ShipHelp.org or call 877-839-2775. These are nonprofit programs that provide unbiased, individual health insurance advice and assistance.

You can also report any misleading MA claims to the Senior Medicare Patrol Resource Center at SMPResource.org or by calling 800-447-8477.

Send your senior questions to: Savvy Senior, PO Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of the book The Savvy Senior.