David Lipschutz, JD
David Lipschutz, JD, associate director of Center for Medicare Advocacy, a national nonprofit law organization that works to advance access to Medicare coverage, Washington, DC. MedicareAdvocacy.org
A new way to get more from Medicare for less…zero premiums…free dental. If you are 65 or older, you’re probably overwhelmed with ads on TV, radio, social media and in the mail for Medicare Advantage (MA) insurance. Offered by private insurers, these plans are alternatives to traditional Medicare, and you can sign up for one of them during open-enrollment season from October 15 through December 7.
MA plans have exploded in popularity because they are touted as low-cost options that come with myriad benefits. In fact, the average Medicare beneficiary can choose among 43 different MA plans.
But beware: The Federal government has deemed many claims in MA ads “fraudulent” and “misleading.” Some ads imply that the Centers for Medicare & 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’s network…or you may end up paying out-of-pocket for medically necessary care.
This past September, the US Department of Health and Human Services began cracking down on these ads, but you still need to practice self-defense…
Stay focused on what’s most important to you in a plan. Does it cover the doctors you like and facilities you normally go to? Are all of your prescription medications on the drug plan’s formulary? Are you eligible for all the benefits you hear about in the ad for the plan? MA plans are organized around networks of providers in defined geographic areas, so a particular plan may not offer certain features in your town.
Reach out to your local State Health Insurance Program (SHIP) at
SHIPHelp.org or call 877-839-2675. These nonprofit agencies are funded by the federal government through the Administration for Community Living, a branch of Health and Human Services. They are available in every state to help you navigate Medicare’s complexities by providing unbiased one-on-one counseling and assistance to individuals, their families and caregivers.
Investigate free vision, hearing and dental benefits. MA plans often include such benefits, unlike traditional Medicare, but the ads may exaggerate the advantages. Examples: 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.
Be realistic about claims that there are no monthly premiums. Even if it’s true, you are 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’t 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.
Report misleading claims to the Senior Medicare Patrol Resource Center at SMPResource.org/you-can-help/report-fraud or by calling 800-447-8477.
