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Medicare Advantage Commercials

Information extracted from Forbes.

In early February 2020, a Forbes contributor spent a lot of time checking the "half-truths" statements in these commercials.

As people watched television over the last several months, many probably saw, and are still viewing, a slew of commercials for Medicare advantage plans.

Another former NFL star has even started promoting advantage plans. All the commercials, no matter about the narrator, talk about the Medicare benefits you deserve and that you should be receiving.

The benefits are listed in a very big and bold font, and encourage the viewer to call the toll-free number and sign-up today!

According to federal law, whatever is seen or heard in an advertisement must be truthful and not misleading. The Forbes contributor, Diane Omdahl, spent time closely watching several different commercials. Everything that was said about the cost and benefits was true, to the extent that is was said. But there was much left unsaid which is important information needed to make a smart decision.

The Benefits:

"Get the benefits you deserve, including rides to medical appointments, private home aides, nurse and doctor visits by telephone."

Medicare describes these benefits for daily maintenance and does not cover them. However, because of policy changes, Medicare advantage plans can now cover them. The plan, not Medicare, must cover these costs. This is a new program and not that many plans offer these benefits. 

Here are some important points not mentioned in the commercials:

A) These benefits are 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.

B) The plan most likely requires prior approval or authorization. Before receiving care the plan must review and approve the physician's order.

C) There are no 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 a year.

D) And, most important, the plans require members to select only one benefit per calendar year. 

In some commercials, there are two more benefits that require clarification.

"Free preventive screenings." Medicare covers a long list of preventive and screening services.

A person does not need to enroll in one of these plans to get preventive services. 

"A 75% discount on prescription medications" in the coverage gap." A person sees this and thinks, "Wow! A big discount on drugs! Where do I sign?"

However, as with preventive services, this benefit is not unique to Medicare advantage plans.

Note: The coverage gap is more commonly known as the donut hole which closed in 2020. 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 type of advantage plans that already include drug coverage, or with a stand-alone Part D drug plan."

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 small line of type appears on the bottom of the screen. It's there for only four (4) seconds, while the list of benefits continues. 

The small type reads, "Plan premiums, co-payments, and coinsurance can apply." 

Note: 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 ($6,700).

That's how much a person could write in checks when something happens, like a cancer diagnosis or injuries suffered in a major car crash. In 2019, the average limit was $5,059" 

The Telephone 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 will be transferred to a randomly selected licensed insurance agent in a call center. 

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.

"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." 

Accordingly, the American Medical Association (AMA) passed the following resolution in the fall of 2019:

"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 encourages 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.

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!