Misleading television advertisements are on almost every channel these days and they get worse each year. The truth about all those Medicare commercials is that they use fear tactics to get you to call. These commercials are well-known in the industry, and they border on illegal as they, repetitively, break marketing rules established by Centers for Medicare and Medicaid (CMS).
How can so many of those Medicare commercials advertise all kinds of “benefits added to your social security check absolutely FREE,” if it isn’t true? Money added back to your check, expanded dental, $0 copays, the list is endless. They tell you that you will miss out and time is limited. So, why doesn’t CMS do something to stop them? I’ll try and answer that later.
Here is where I will tell you if there is any truth to all those wonderful things they tease you with. I will add to this list as I become aware of additional items that should be included so don’t hesitate to let me know if I missed anything. With that said, here we go.
The Claim: You can get up to $144 a month added back to you Social Security check.
The Truth: This is a commercial from 2019-2020. $144 was the Medicare Part B premium amount. In 2021, the Medicare Part B premium is $148. If someone qualifies for Extra Help with prescription drugs, they may get this amount credited back to their check. To qualify for Extra Help with medications, you must meet income qualifications which are based on the Federal Poverty Level. You must, also, be enrolled in a Prescription Drug Plan.
The Claim: You can get up to $148 a month added back to your Social Security check.
The Truth: See previous scenario.
The Claim: You may be able to get $1700 added back to your check each year
The Truth: This is just another way to tell you that you can get the Medicare Part B premium credited back to your check each month if you qualify for Extra Help. Keep in mind, this is based on income.
The Claim: $100 a month added back to your Social Security check
The Truth: This is a “give-back” plan. These are only available in certain areas and $100 would be the one the highest “give-back” plans and is only in limited areas. In exchange for a “give-back” of any amount, you will trade low copays and extra benefits for this.
The Claim: You may be eligible for a plan that “give you money back”
The Truth: Some Medicare Advantage plans in certain areas, have what is called a Part B Premium Reduction. Basically, you will receive a set amount credited back to your Social Security check for each month you are enrolled in the plan. This is not the same as Extra Help. In exchange for the “give back” you may have much higher copays and see a reduction in extra benefits that may be available on other plans.
The Claim: Get money added back to your Social Security Check
The Truth: A variation of the “give-back”, “$144 added back”, and “$1700 a year “. It encompasses all these scenarios I mentioned earlier.
The Claim: $0 copays
The Truth: Many Medicare Advantage plans offer $0 copays for PCPs and certain services. There is nothing extraordinary about this.
The Claim: You can eliminate deductibles
The Truth: This statement is designed to attract people on Medicare Supplements – these are different than Medicare Advantage plans. Most Medicare Advantage plans have no health deductibles – you just have copays and coinsurance only, from day one. In a few zip codes you may find Medicare Advantage plans with very small health deductibles. Note: Once you drop your Supplement, you may never get it back.
The Claim: Prescription Drugs for free
The Truth: The first phase of all drug plans is the Deductible Phase during which you may have a deductible up to $480 (2022 plans). This means a drug deductible may be $0, $480, or any amount in between. Additionally, some Medicare Advantage Prescription Drug plans and some stand-alone Prescription Drug Plans may apply the deductible to only certain Tiers and some plans have low or $0 co-pays for low Tier medications.
The Claim: Discounts on medications during the Coverage Gap
The Truth: The third stage of all drug plans is commonly referred to as the Donut Hole or Coverage Gap. During this stage, you pay 25% of the cost of medications – this may feel like your insurance is not helping but it is. The commercial leads you to believe that there is some other magical discount available on some plans but there is not. Note: Not everyone enters the Coverage Gap.
The Claim: “Expanded Dental”
The Truth: Medicare Advantage plans are allowed to include supplemental benefits in the amount they choose which means one may have more dental and another plan may have no dental. There is no way to “expand” your coverage. A plan offers what it offers but you may be able to purchase optional dental.
The Claim: Transportation or rides to medical appointments
The Truth: Some plans offer medical transportation to and from doctors’ appointments, etc. Some plans do not. If you have a Medicare Advantage plan with a transportation benefit, most work the same. You must schedule several business days in advance. They will tell you what time they will pick you up depending on your appointment time. Do not be surprised if they pick you up and get you there earlier than you would prefer but keep in mind, if traffic is unexpectantly snarled, it is still there job to get you there on time so they plan for what-ifs.
The Claim: Free meals, healthy meals, etc
The Truth: Some plans offer limited meal assistance after a covered hospital stay. These meals are at the plan’s discretion and are minimal in number.
The Claim: You may be entitled to extra benefits but don’t get them automatically
The Truth: If you have a Medicare Advantage plan with any additional benefits, you do not have to do anything special to gain access to them. You do not have to reapply each year. You do not lose them each year. Even if the benefits on your plan change from year to year, you will still have full access to them just by being enrolled in the plan.
The Claim: You need to confirm your enrollment (this indicates you may lose your plan or benefits if you do not call)
The Truth: If you are enrolled in a Medicare Advantage plan, you do not need to do anything to keep your plan for the following year unless your plan leaves the service area. This is not common but when it happens, the plan will notify you in advance. You will be provided a Special Enrollment Period to enroll in another Medicare Advantage or Prescription Drug Plan.
The Claim: Free Preventative Screenings
The Truth: All health insurance plans cover preventative screenings which include annual wellness exams, mammograms, prostate exams, colonoscopies, and so much more.
The Claim: Flexible Spending Account, Flex cards
The Truth: Some plans may include spending amounts, specific to that plan, that a member may use. Some plans offer this to be used on dental/vision/hearing or other items as specified by the plan. This is just another of offering an extra benefit.
The Claim: Groceries
The Truth: Some plans offer food cards that can be used at participating grocery stores. This is most common on plans designed to address special needs.
The Claim: Over-the-counter (OTC) items, vitamins, supplements, etc
The Truth: Some plans offer OTC in various amounts.
The Medicare commercials are designed to play upon emotions. In fact, Centers for Medicare and Medicaid (CMS) has sent out word they expect companies to submit their advertisements for approval because of the rampant abuse of allowable marketing tactics. The first problem is, CMS is allowing companies to continue them until told to stop – which may be a long while. Problem two, there are hundreds of these commercials across the nation CMS needs to review for compliance while reviewing thousands of other marketing pieces such as phone scripts, websites, paper mail, radio ads, etc. Honestly, I don’t know when, or if, there will be any measurable improvement.
So, in the meantime, how do you know what is legitimate? You must be smart. Remember the old adage: If it sounds too good to be true, it probably is.