Medicare is medical insurance sponsored by the U.S. government. It is open to individuals over the age of 65. There are two basic parts of Medicare, Part A (hospital coverage) and Part B (medical insurance). There is also optional part D (drug coverage) and Part C, called Medicare Advantage.
Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to traditional Medicare for your health and drug coverage. These "bundled" plans include Part A, Part B, and usually Part D and they often offer some benefits not covered by traditional Medicare, such as dental insurance and they generally do not have the copays of traditional Medicare, which covers only 80 percent of eligible expenses. There are private insurance plans that cover the costs Medicare does not cover.
Individuals become eligible to enroll in Medicare when they are within three months of turning 65. Annually, everyone covered by Medicare or a Medicare Advantage plan has the opportunity to review plans available in their area and if they choose move into another plan.
This annual enrollment window opened Oct. 15 and closes Dec. 7. During this period companies offering Medicare Advantage plans advertise heavily to promote enrollment in their plan. Sometimes, these ads sound more like an ad for a car than promotion of a serious decision that can have significant health and financial consequences.
Insurance companies offering Medicare Advantage plans advertise heavily because of how they are funded. Medicare pays the insurance carrier whenever someone enrolls, so it is a benefit to insurance companies to encourage enrollment in Advantage plans.
Sometimes these ads are deceptive, like with mailers designed to look like official government forms or with TV commercials featuring celebrities who encourage people to sign up for Advantage plans that do not include their current doctors or their current prescriptions and which may drive up their out-of-pocket costs.
Advertisements for Medicare Advantage plans are required to conform to certain standards of accuracy, but there have been complaints about misleading advertising and high pressure tactics of some agents to get people to sign up.
There have been enough complaints that the Centers for Medicare and Medicaid Services (CMS) sent an Oct. 19 memo to insurers that said the agency has reviewed thousands of complaints and hundreds of audio calls and have identified numerous issues with information provided to beneficiaries that is confusing, misleading or inaccurate.
As a result, the agency said, starting Jan 1, 2023 all television ads must be approved beforehand and CMS will review all previously submitted TV ads to confirm that the materials meet agency requirements.
We believe this is an appropriate measure, and we are encourage that the agency is taking steps to protect seniors from unscrupulous companies that make false promises and lead people into contracts that do not deliver what is expected.
There is an old advertising adage that says "you sell the sizzle, not the steak," but in making a decision about Medicare Advantage or traditional Medicare, consider not just the sizzle of initial cost and the promised benefits, but evaluate the steak. Compare plans based on whether the doctors you see are included, whether the prescriptions you take are covered, what are the requirements for pre-approval for medical procedures or for seeing a specialist.
Medicare Advantage advertising can be misleading, so instead of buying on an ad, buy on information from the source, CMS.gov for Centers for Medicare and Medicaid and medicare.gov for information about Medicare. The plans can be confusing, but both sites have an option for talking with a representative for assistance.