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What TV ads don't reveal about Medicare Advantage

 

Last updated 10/27/2022 at 3:54pm | View PDF



The Medicare open enrollment period runs through Dec. 7.

Medicare recipients have two choices for covering their medical expenses not paid by Medicare Parts A and B: a “supplemental” plan, also called Medigap, or a Medicare Advantage plan (also known as Medicare Part C)

You’ve probably seen the commercials for the Medicare Advantage option.

Buyers, beware! Medicare Advantage is allowed to advertise without disclosing the downsides compared to the traditional Medicare plus supplemental, including these:

• Medicare Advantage is privatized and run by insurance companies for profit, costing the government more than traditional Medicare. Tactics may include denial of coverage for necessary treatment, adding more lucrative diagnosis codes, and limiting the pool of doctors and health care facilities where you can be treated without a substantial copay.

• By contrast, almost all doctors and hospitals in the U.S. accept traditional Medicare.

• Unlike traditional Medicare, Advantage plans may be limited to a small geographic area. Out of area, you will be hit with out-of-network copays.

• Those no-premium Advantage plans advertised on TV are really HMOs. You will need approval from a gatekeeper before you can see a specialist or schedule a procedure. Advantage plans are not free — there are copays for most interventions.

• If you want to be reinstated into traditional Medicare from Medicare Advantage, you may be denied a Medigap plan outright or charged a much higher premium.

The burden is on the consumer to locate objective information on Advantage versus traditional Medicare. — Linda Burke, Hinsdale

 
 

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