{"id":4020,"date":"2023-10-20T13:50:27","date_gmt":"2023-10-20T17:50:27","guid":{"rendered":"https:\/\/communicator.pef.org\/?p=4020"},"modified":"2023-11-21T10:06:37","modified_gmt":"2023-11-21T15:06:37","slug":"retirees-in-action-when-it-comes-to-medicare-if-it-sounds-too-good-to-be-true","status":"publish","type":"post","link":"https:\/\/communicator.pef.org\/issue\/volume-41-no-9\/retirees-in-action-when-it-comes-to-medicare-if-it-sounds-too-good-to-be-true\/","title":{"rendered":"Retirees in Action: When it comes to Medicare, if it sounds too good to be true…\u00a0"},"content":{"rendered":"

\"PEFNovember 21, 2023 —<\/em> Do you ever wonder why there are so many ads, mailings, and solicitations for Medicare Advantage Plans? The for-profit private insurance industry spends a lot of money on promoting private for-profit Medicare plans. My recommendation to retirees is to join traditional Medicare and keep your employer-sponsored NYSHIP Supplemental plan which covers what Medicare doesn\u2019t.<\/span>\u00a0<\/span><\/p>\n

I came upon the article below in my Sunday newspaper, which runs a weekly \u201c<\/span>Savvy Senior<\/span><\/a>\u201d column written by Jim Miller. I\u2019m sharing it because it does a good job of explaining Medicare Advantage plans.<\/span>\u00a0<\/span><\/p>\n

\u201cQ: I\u2019m currently enrolled in original Medicare but have been thinking about switching to a Medicare Advantage plan during the open enrollment period. Many of the Medicare Advantage ads I\u2019ve seen offer lots of extra benefits beyond what traditional Medicare offers and no monthly premiums. What are your thoughts?<\/span>\u00a0<\/span><\/p>\n

A: Be very leery of the Medicare Advantage ads on TV, radio, social media, and that come in the mail. While many of these ads may tout free vision, hearing, dental and other benefits with zero monthly premiums, they aren\u2019t always what they claim to be.<\/span>\u00a0<\/span><\/p>\n

Advantage basics<\/span><\/b>\u00a0<\/span><\/p>\n

Medicare Advantage or MA plans (also known as Medicare Part C) are government- approved health plans sold by private insurance companies that you can choose in place of original Medicare. The vast majority of Advantage plans are managed-care policies such as HMOs or PPOs that require you to get your care within a network of doctors in a geographic area.<\/span>\u00a0<\/span><\/p>\n

MA plans have exploded in popularity in recent years as insurers have flooded the airways with advertisements, often by celebrity pitchmen, that promote low-cost options with lots of extra benefits.<\/span>\u00a0<\/span><\/p>\n

But be aware that the federal government has deemed many claims in MA ads fraudulent and misleading. Some ads imply the Centers for Medicare and Medicaid Services endorses or prefers a specific plan. Others promise more cost savings than you really get. And if you choose the wrong plan, your doctor may not be a member of that plan\u2019s network, or you may end up paying out-of-pocket. This past September, the U.S. Department of Health and Human Services began cracking down on these ads, but you still need to practice self-defense.<\/span>\u00a0<\/span><\/p>\n

Cover your needs<\/span><\/b>\u00a0<\/span><\/p>\n

When evaluating MA plans, make sure the ones you\u2019re considering cover the doctors you like and the health care facilities you normally go to. Also, make sure all of the prescription medications you take are on the drug plan\u2019s formulary.<\/span>\u00a0<\/span><\/p>\n

To help you compare plans, a good first step is to call the office managers of the doctors you use and find out which Advantage plans they accept, and which ones they recommend. Then go to the <\/span>Medicare Plan Finder tool<\/span><\/a> to compare plans in your area.<\/span>\u00a0<\/span><\/p>\n

Understand the details<\/span><\/b>\u00a0<\/span><\/p>\n

Some MA plans promote no monthly premiums, but the reality is that you are still responsible for your original Medicare costs including your Part B premium and deductibles and copays for covered services. Moreover, you may have to pay more out of pocket if you see a doctor outside the network. Also, if the plan is an HMO, it generally doesn\u2019t cover non-emergency care out of network, so an individual may be responsible for full costs. A PPO on the other hand, allows people to go out of network, but they generally have to pay more to do so. Many MA plans tout free vision, hearing and dental benefits that are not covered by traditional Medicare, but these benefits are often limited. For example, a plan that offers free dental coverage may cover only cleanings and x-rays. Extensive procedures such as root canals or caps may not be covered, or the plan may limit the dollar amount it pays.<\/span>\u00a0<\/span><\/p>\n

Get help<\/span><\/b>\u00a0<\/span><\/p>\n

Reach out to your local State Health Insurance Assistance Program (SHIP) at <\/span>ShipHelp.org<\/span><\/a> or call 877-839-2775. These are nonprofit programs that provide unbiased one-on-one Medicare counseling and assistance.<\/span>\u00a0<\/span><\/p>\n

You can also report any misleading MA claims to the Senior Medicare Patrol Resource Center at <\/span>SMPResource.org<\/span><\/a> or by calling 800-447-8477.\u201d<\/span>\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

November 21, 2023 — Do you ever wonder why there are so many ads, mailings, and solicitations for Medicare Advantage Plans? 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