Posts Tagged "Medicare Advantage plan"
January 19, 2023
What’s Up with Medicare Advantage Ads?
Starting months before my 65th birthday, my mailbox has been swamped with advertisements for Medicare Advantage insurance plans. The ads are still coming in.
And then there are the television commercials with promises of Advantage plan benefits that original Medicare doesn’t cover – vision, dental and hearing services, rides to doctors’ appointments, zero premiums. Sounds amazing, doesn’t it?
The advertising blitz surely has contributed to the doubling in Advantage plan enrollment since 2013, to 28 million last year. The plans are overtaking Medigap plans, which the nonprofit Commonwealth Fund estimates do not bring in as much profit for brokers as Advantage plans.
It is true that the vast majority of Advantage plans provide some type of vision, dental and hearing coverage. And retirees with these benefits in their Advantage plans spend slightly less for the services than other retirees, the Kaiser Family Foundation, a healthcare non-profit, found.
But the devil is in the details.
For example, the average dollar limit for vision benefits in Advantage plans was $160 in 2021, said Meredith Freed, Kaiser’s senior policy advocate. That $160 probably wouldn’t be enough to pay for an exam and buy the prescription glasses. The television and mailed advertisements are short on these details.
Or consider dental coverage for preventive services, such as cleanings and X-rays. This coverage might be useful, but the plan might not cover cavities, root canals and caps. Or, if they are covered, a $1,000 limit is fairly common and insufficient for many expensive procedures, Freed said. And what about the two out of three Advantage plans that do not charge a premium? The ads touting “zero premiums” aren’t usually clear that you’re still responsible for Medicare’s Part B premium of $164.90 per month.
“I’m hesitant to use the word misleading,” Freed said. But when choosing a Medicare Advantage plan, “Unfortunately, it’s on the consumer to dig more when they’re interested in a plan” to understand not only how the specific plans work but also how Medicare’s underlying benefits work, she said.
An analysis of Google search data has found that older Americans are not finding the kind of information online that they are seeking about their Medicare options. Instead, they are being bombarded with advertising by insurance companies, agents, and brokers, according to the Commonwealth Fund.
Older people search for Medicare information online from a diverse range of sources – patient advocacy groups, the media, and federal agencies including Social Security and the Centers for Medicare and Medicaid Services (CMS). A minority of the searches are for insurance industry information.
June 9, 2022
Get Help with Medicare Coverage Denials
The United States has a notoriously complex healthcare system, and Medicare is no different.
In the early months of the pandemic, the Medicare Rights Center received a large number of calls to its telephone help line from people over 65 who had suddenly been laid off and lost their employer coverage. Even when there isn’t a crisis, the center’s staff and volunteers answer all manner of questions about Medicare enrollment rules, insurance options, and what to do when an insurance company denies them coverage.
Sarah Murdoch is the center’s director of client services and oversees the helpline. She spoke with Squared Away about the common issues retirees face and how they can address them.
Question: Your helpline fielded 42,000 questions about Medicare in 2020 and 2021. How does that compare to past years?
It’s in that ballpark year to year – around 20,000 questions. But we saw, within that 42,000, a shift in the actual trends.
Throughout the pandemic, particularly in 2020 when there were lockdowns and people were getting laid off left and right, we got a lot of calls from people who unexpectedly had no income. We heard from people who had insurance through their job and that was not an option anymore. Or they were already on Medicare and were trying to figure out how to pay their costs, or they were laid off and had to figure out how to get into Medicare. That has eased up but was a big thing we saw in the beginning of the pandemic.
We also had questions related to benefits for low-income people. We told people who suddenly had zero income about the income requirements for the Medicare Savings Program, Medicaid, and the state pharmaceutical assistance programs – anything that can lessen the hardship.
In 2020 and 2021, nearly a third of the complaints on your helpline were about service denials by insurers that provide Medicare Advantage or Part D drug plans. Start with Advantage plan denials – are they a big issue for retirees?
The Medicare Advantage plans often have doctor and hospital networks, whereas original Medicare doesn’t have networks. People may be denied coverage by an Advantage plan if they have an out-of-network provider. It could also be a denial of a medical service or a prescription medication. We do see it more but it’s hard to tease that out from the fact that more people are just enrolled in Medicare Advantage.
Do Medigap supplements to Medicare have similar issues with denial of coverage?
Medigap is different – the plans are never making their own claim determinations. If something is approved by original Medicare, then Medigap is going to pay for it as long as the retiree has a Medigap plan that has that type of coverage. In the Medicare Advantage policies, however, insurers are making the claims determination. All of the insurance companies have their own claims adjusters making those decisions – as opposed to contractors who process claims for the Medigap plans on behalf of the Centers for Medicare and Medicaid Services. The Medigap insurer isn’t making any decisions as to whether something is covered or not – it has already happened at the government level. …Learn More