By Ron Iverson, President of the National Association of Medicare Supplement and Medicare Advantage Producers
Sick of the Medicare TV commercials yet? They’ve made their way into major network programming and still keep appearing in senior interest market networks. I don’t expect they will subside until after [the January 1 – March 31 Open Enrollment Period] OEP, if then. Either TV advertising is too cheap, or the people who run the ads are making a lot of money off of them–enough to keep running them.
Forbes ran an interesting article by Forbes Contributor, Diane Omdahl, last week headlined, “Half-Truths and Medicare Advantage Commercials.” She spent a lot of time fact-checking the statements and started her story like this:
“If you watched any television in the last several months, you probably saw a slew of commercials for Medicare Advantage plans. One that pops up frequently features a former professional football player who once did a commercial wearing pantyhose. His commercials must be working so well that another former NFL star has also started promoting Medicare advantage plans. All the commercials, no matter the narrator, talk about the Medicare benefits you deserve and that you should be getting. They list those benefits in a very big and bold font and encourage you to call the toll-free number and sign up today.”
“According to federal law, whatever we see or hear in an advertisement must be truthful and not misleading. I spent some time the last few days closely watching several different commercials. Everything that was said about the cost and benefits was true, to the extent that it was said. But there was much left unsaid, and that’s important information you need to make a smart decision.”
“First, the benefits: ‘Get the benefits you deserve, including rides to medical appointments, private home aides, nurse and doctor visits by telephone.’ Medicare describes these as benefits for daily maintenance and doesn’t cover them. However, because of policy [and funding] changes, Medicare advantage plans can now provide them. The plan, not Medicare, must cover these costs. This is a new program and not that many plans offer these benefits. Based on my preliminary plan research, here are some important points not mentioned in the commercials:”
- These benefits appear to be 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.
- The plan likely requires prior approval or authorization. Before receiving care, the plan must review and approve the physician’s order.
- There are 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 aid four hours a day for no more than 31 days a year.
- And, most important, the plans we researched require members to select only one benefit per calendar year.
“In some commercials, there were two more benefits that require clarification. ‘Free preventive screenings.’ Medicare covers a long list of preventive and screening services. You don’t need to enroll in one of these plans to get preventive services. ‘A 75% discount on prescription medications in the Coverage Gap.’ You see this and think, ‘Wow! A big discount on drugs! Where do I sign? However, as with preventive services, this benefit is not unique to Medicare advantage plans.”
“The coverage gap is more commonly known as the donut hole. In 2020, the donut hole closed. Beneficiaries are responsible for 25% of the cost of medications in this payment stage. 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 plans in the commercials, some other Medicare advantage plan with drug coverage, or a stand-alone Part D drug plan.” Note: this is like extolling a certain make of automobile because it comes with four wheels.
“Second, 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 seconds, while the list of benefits continues. The small type reads, ‘Plan premiums, co-payments, and coinsurance can apply.’ ”
“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. That’s how much a person could write in checks when something happens, like a cancer diagnosis or a major car crash. In 2019, the average limit was $5,059.”
“Third, the 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’ll be transferred to a licensed insurance agent. 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.”
Then, Omdahl, who has written about health matters for thirty years, asks a question. “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. She then refers to the American Medical Association (AMA), which in the fall of 2019 passed a resolution.
“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.”