Two new reports, one from the Commonwealth Fund and one from the Kaiser Family Foundation, highlight the deceptive marketing in Medicare Advantage, a program administered by corporate health insurers that too often misrepresents their benefits and costs. Many Medicare Advantage plans fail to cover the care, particularly the costly care, their enrollees need. In short, if you want care from the doctors you know and trust, without insurance companies overruling their treating decisions, you should enroll in Traditional Medicare.
The marketing of Medicare Advantage has meant endless ads everywhere you turn. There’s literally hundreds of billions of dollars in profits available to be reaped by corporate health insurers each year. And, they want as much of these profits as they can get their hands on. The problem is that they profit more when their enrollees get less care.
With lots of people complaining about countless marketing calls, misleading advertising and unscrupulous sales tactics, the Biden administration has put in place new regulations in the past year. It’s not at all clear that they work, given that the corporate health insurers know that they can get away with a lot and face little if any accountability for their bad acts.
The Commonwealth Fund survey found that sales agents wrongly asked people for their Social Security or Medicare numbers in many cases. You should not give this information out; it is not allowed in most instances.
People are generally overwhelmed by their Medicare choices. They have too many options and it is virtually impossible to distinguish among them. So, they often stay with their current coverage.
The Kaiser Family Foundation reports that “in 2023, Medicare beneficiaries can choose from an average of 43 Medicare Advantage plans, offered by 9 different insurers, the highest number ever available. Traditional Medicare beneficiaries selecting prescription drug coverage can choose from an average of 24 stand-alone Part D plans.”
A lot of people turn to friends and family for advice. Others rely on insurance brokers. Don’t trust insurance brokers who profit from steering you to particular Medicare Advantage plans. Contact your state health insurance assistance program, SHIP, or the Medicare Rights Center at 800-333-4114 for free unbiased counseling.
In the Commonwealth survey, about a third of people with Medicare wanted to know more about their out-of-pocket costs and benefits in a Medicare Advantage plan v. Original Medicare. It’s critical people understand them as there have been a large number of complaints from people with Medicare about misleading information by the Medicare Advantage plans and the insurance brokers they hire about costs and benefits. Unfortunately, costs and benefits are not as simple to understand as they should be.
Here’s what you need to know: In Medicare Advantage, out-of-pocket costs can be as high as $8,300 in 2023 for in-network care, and you will pay for the full cost of care if you go out of network. Because many plans engage in widespread denials and delays of care and have networks with limited numbers of physicians, it can be hard to get in-network care.
And, as for the “extra” dental and hearing benefits that many Medicare Advantage plans promote, beware. They sound great in theory, but are often difficult to take advantage of. In many cases, you must use a set of providers who are inconvenient or unavailable or your out-of-pocket costs can be extremely high. The data show that more people in traditional Medicare get dental care than in Medicare Advantage.
Here’s more from Just Care:
- Medicare Advantage: Tune out the Joe Namath ads
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Need a shrink? Your Medicare Advantage plan might not think so
- Ohio and Virginia hospitals warn residents they could stop taking Medicare Advantage patients
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