I’m currently enrolled in Original Medicare, but I’m considering switching to a Medicare Advantage plan during the open enrollment period. Many of the ads I’ve seen for Medicare Advantage offer many additional benefits beyond what traditional Medicare offers, with no monthly premiums. what are your thoughts?
Considering a switch
For those who are considering it,
Be wary of Medicare Advantage ads you receive on TV, radio, social media, and in the mail. Many of these ads tout zero monthly premiums and free vision, hearing, dental, and other benefits, but that’s not always what’s advertised.
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 as an alternative to Original Medicare. The majority of Advantage plans are managed care policies, such as HMOs and PPOs, that require you to receive care within a network of physicians within your geographic area. You can sign up for either during the general registration period from October 15th to December 7th.
MA plans have exploded in popularity in recent years as insurance companies flood airways with advertisements touting lower-cost options with many additional benefits. The advertisements are often from celebrity touts.
Note, however, that the federal government considers many claims in MA ads to be fraudulent and misleading. Some advertisements imply that the Centers for Medicare and Medicaid Services endorses or recommends a particular plan. Some companies promise more cost savings than they actually receive. Additionally, if you choose the wrong plan, your doctor may not be a member of that plan’s network or you may end up paying out-of-pocket for medically necessary treatment.
In September of this year, the U.S. Department of Health and Human Services began cracking down on these ads, but you should still protect yourself. Here are some tips to help you make the right decision.
Cover your needs: When evaluating MA plans, make sure the plan you’re considering covers your preferred doctors and the medical facilities you usually go to. Also, make sure that all prescription drugs you take are listed on your drug plan’s prescription list.
To compare plans, a good place to start is to call your doctor’s office manager to find out which Advantage plans are accepted and which are recommended. Next, visit the Medicare Plan Finder tool at Medicare.gov/plan-compare to compare plans in your area.
Understand the details: While some MA plans offer free monthly premiums, they actually include Part B premiums, deductibles and copays for covered services, You are still responsible for your original Medicare costs. Additionally, you may have to pay more out-of-pocket if you see an out-of-network doctor. Also, if the plan is his HMO, it typically does not cover out-of-network non-emergency care, so the individual may be responsible for the full cost. PPO, on the other hand, allows you to go out-of-network, but you usually have to pay more to do so.
Let’s look into it a little more closely. Many MA plans advertise free vision, hearing, and dental benefits not covered by traditional Medicare, but these benefits are often limited. For example, a plan with free dental coverage may only cover cleanings and his x-rays. Extensive procedures such as root canals and caps may not be covered, or your plan may limit the amount paid. Check your coverage details to avoid surprises later.
Get help: Contact your local State Health Insurance Assistance Program (SHIP) at ShipHelp.org or call 877-839-2775. These are nonprofit programs that provide unbiased, one-on-one Medicare counseling and assistance.
You can also report misleading MA claims to the Senior Medicare Patrol Resource Center at SMPResource.org or by calling 800-447-8477.
Send 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.”
