When it comes to Medicare, every corporate health insurer seems to have an offer you can’t refuse, often from one of your favorite heroes paid to push their products. Don’t be misled by the TV ads and other promotional hype; get impartial information from your State Health Insurance Assistance Program. And, if you are misled, please know that you now have special rights to disenroll.
Millions of older adults and people with disabilities are receiving misleading information from insurance companies offering Medicare Advantage. These insurers are not telling you the whole story about the health plans they are offering. Medicare Advantage plans offer you coverage from a limited number physicians and hospitals–generally far fewer than it appears from their provider directories–and often with large out-of-pocket costs if you need costly care. And, you are likely to need prior approval for your care, as well as to face delays and denials of care.
So many people are signing up for these health plans based on misleading information that the Centers for Medicare and Medicaid Services (CMS) has threatened to penalize Medicare Advantage plans if they or the insurance brokers selling their products mislead people, reports Susan Jaffe for California Healthline. Under federal law, they are not allowed to engage in deceptive marketing practices, but that has not stopped them. And, since marketing is always deceptive–highlighting benefits but not costs–what exactly constitutes deceptive marketing?
CMS is seeing a lot of complaints. Does the punishment CMS is threatening fit the crimes the health plans are committing? The Medicare Advantage plans make so much money off of each enrollee that it can be highly profitable for them to try to sell people a free lunch. When asked, CMS could not name one instance in which it had fined or suspended enrollment in a Medicare Advantage plan for deceptive marketing.
The good news is that CMS has added new protections for people who are misled into joining a Medicare Advantage plan. You have additional rights to disenroll beyond the first three months of the year. According to CMS, enrollees have a “special enrollment period” if you want to disenroll because of deceptive sales tactics, including “situations in which a beneficiary provides a verbal or written allegation that his or her enrollment in a MA or Part D plan was based upon misleading or incorrect information … [or] where a beneficiary states that he or she was enrolled into a plan without his or her knowledge.”
Most important: Never give a stranger your Medicare or Social Security number. In some cases, insurance agents are calling people, asking for their Medicare number and enrolling them in a Medicare Advantage plan without telling them.
If you want health insurance that will meet your needs if you take a bad fall or are diagnosed with a serious condition, traditional Medicare gives you the freedom to see the doctors you want to see and use the hospitals you want to use anywhere in the country, generally with no bureaucratic hassle. The tradeoff is that you will need supplemental coverage, either through Medicaid, a former employer or a Medigap plan in order to protect yourself from out-of-pocket costs that have no cap. But, the cost of Medigap can be as low as $1,500 a year, far lower than the out-of-pocket cap in Medicare Advantage, which averages around $5,000 a year and can be as high as $7,550 for in-network care alone.’
Here’s more from Just Care:
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Well-kept secrets of Medicare Advantage plans
- If you’re making a Medicare choice, don’t trust the insurance agent
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Don’t judge a Medicare Advantage plan by its stars
Leave a Reply