By Kelly Stalnaker
Aside from your initial Medicare enrollment and “special” enrollment for life changing events (moving to a new address, losing your coverage, etc.), you can only make changes to your Medicare plan during the Open Enrollment Period. From October 15 through December 7 only, you can join, drop or switch to another Medicare plan. Since this enrollment period only happens once a year, it is very important that you are well educated about the advantages and disadvantages of various Medicare policies.
According to a Kaiser Family Foundation study, seniors are inundated by ads for Medicare Advantage plans, noting that over 9,500 commercials air daily on the television. Additionally, a survey of seniors found that more than 30% report receiving calls daily from representatives selling advantage plans. These aggressive advertising techniques are proving to be successful as over half of seniors are currently enrolled in privatized Medicare plans. But, these flashy ads have been shown to be misleading and do not always tell the whole story.
Journalists at Prospect.org found that many ads are inaccurate, citing “[The ads] neglect to say that the amount of coverage you get is limited. They don’t talk about what you are losing by leaving traditional Medicare.” The plans claim to help lower costs, allow for ease of use with just one all-encompassing policy as opposed to several separate plans, and offer additional benefits such as gym memberships. But they fail to mention the restrictions that will undeniably affect your healthcare.
According to Medicare.gov, Medicare Advantage plans have closed-provider networks that often require prior authorizations for various medical procedures. More importantly, patients have less freedom in choosing their own healthcare providers, “In some areas, it can be difficult to find a local doctor or hospital that works with Medicare Advantage. And if you visit a doctor or hospital that isn’t “in-network,” you will pay higher out-of-pocket costs.” Finally, Medicare Advantage plans do not always work as well with supplemental retiree coverage, potentially resulting in higher copay costs for patients.
The misrepresentation of these plans, combined with the excessive barrage of advertising has become such a concern that Washington D.C. is getting involved. Criticizing the widespread and predatory marketing of Medicare Advantage plans, along with the rapidly increasing consumer complaints, many federal agencies are working together to monitor the issues and develop clear guidelines for ethical advertising practices. For example, in August 2022, the Federal Trade Commission forced one company with a very prominent spokesman to repay $100 million for fraudulent activities.
We at J&B Medical are so thankful for our Medicare patients, but have unfortunately been forced to turn away long-time patients who switched to Advantage plans and we are no longer in network. Do not simply take the information provided by an Advantage plan salesperson at face value. Ask a lot of questions before making the switch. Prior to committing to a new plan, it would be beneficial to contact all of your providers to confirm they will continue to be in network. Time spent doing research ahead of a change in your plan may avoid headaches and higher costs in the long run.
