The Truth About Medicare Commercial Claims

You cannot watch TV today without seeing commercials for Medicare promising “extra benefits” you “may” be entitled to. During the coming AEP, the number of commercials and claims they make are sure to be worse. Let’s clear this mystery up once and for all so that you are not fooled when you see them:

  • These commercials are really talking about nothing more than Medicare Advantage Plans. If you are in one you know exactly what they are. If you are not, these plans are network plans where Medicare is no longer your insurance (although you are still in the Medicare system) but the insurance company that you pick becomes the primary insurance.
  • When you are in a Medicare Advantage Plan, Medicare is no longer responsible for any of your medical costs because Medicare is giving the insurance company you have selected a fee each month (this is the reason why Advantage plans can have a low premium). The commercials never address this.
  • Because the commercials are nationwide, the benefits promised are not necessarily available in your area. In fact, the producers of these commercials make it seem like all the benefits they mention are in all the plans (they are not) and that each benefit is a “complete” benefit. An example would be making it seem that a dental benefit will cover all your dental needs, when most plans just cover basics like cleanings, x rays and exams.
  • Some benefits they mention are only for people who have Medicare AND Medicaid (like getting back all of the premium you pay for Medicare Part B) but it seems like you are entitled to them.
  • The commercials never mention that these plans are network plans and that you are responsible for medical copays that can be as high as 7,550.00 (in network) and 11,300.00 (out of network), depending on the plan, in 2021. Those of you in these plans are aware of this but notice that the commercials never mention it.
  • The call centers that respond to incoming phone calls are usually in a central area so the “agents” answering the phones have no knowledge of the medical groups in a particular area that may be dominate and should be part of the network for the plan a person is being enrolled into (like CareMount in our area as an example).
  • These call centers sell the plans in “blocks” meaning that if on a particular week, or month, the call center is trying to satisfy their contract with a particular insurance company to meet the number of enrollments requirements to satisfy the contract, the person calling will be enrolled in that companies’ plan no matter if it was the best plan for him/her or not.
  • The disenrollment rate for people who call these centers is over 90% from year to year due to dissatisfaction in networks and medications not being properly checked, benefits not being what was promised, etc.
  • There is no such thing as a plan with 0 premium and 0 co-pays for everything (unless you are on FULL Medicaid) but the commercials sometimes try to make it seem that way.

These comments on the Medicare commercials is not a criticism of Medicare Advantage Plans but are criticisms of the exaggerated claims they make about these plans as well as the lack of call centers being in a position to do the due diligence regarding placing people in the plan best suited for them.

So, I hope that the next time you see one of these Medicare commercials you will view them the same way you would a commercial for a fast-food restaurant: what looks good on TV is not what you find to be what the product really is once you see it in person.