Sonia Ashford is the owner of Ashford Insurance, an independent health insurance agency specializing in Texas Medicare insurance.
It seems that nothing ever changes when it comes to hawking insurance to fill the gaps in Medicare coverage for seniors. The fervent sales pitches, the misinformation, and the incomplete and deceptive information continue to proliferate. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. 15 and runs through Dec. 7.
There are some people who will not use their agent or do not have an agent during AEP, and who will not attend an educational or marketing event but are nonetheless susceptible to being misled. A recent report by the Kaiser Family Foundation found that 7 in 10 Medicare beneficiaries didn’t compare MA and Part D plans, and did not widely use Medicare’s own materials. So where do people end up getting much of their information about Medicare?
One need only turn on their TV for a brief period of time before seeing a barrage of advertising for MA and Part D and even Medigap plans, particularly during this time of year. There are a plethora of ads featuring retired athletes and actors pitching general promises of better benefits, but more specifically promoting 1-800 numbers that connect with brokerage firms that sell Medicare Advantage plans.
While it is true that Advantage plans can include these extra benefits, said benefits vary by plan, and plan availability depends on your location. Also important to note is that not every Advantage plan offers the option for home-delivered meals. Further, even if your plan offers home-delivered meals, you must personally qualify to receive them.
Your plan may require co-pays for visits to doctors and specialists, as well as for prescription drugs. Yet, for your Advantage plan to pay at all, your providers must be in your plan’s network. Additionally, your medications and dosages must be on the formulary of your Medicare Advantage prescription drug plan to receive coverage.
The availability of plans with the give-back or premium-reduction feature is dependent on your location and income. The amount the plan reduces your premium can be as much as the standard amount, or it could be less.
These ads have enticed people into making coverage changes that have disrupted their current care and coverage, and are not necessarily in their own best interests. In short, we urge people not to rely on such advertising that paints plans being sold in the light most favorable and does not cover the full range of considerations one should make when making choices about their coverage options.
There is some indication that CMS may be trying to crack down on these types of ads. Last month, CMS released a memorandum to plans stating that it “is particularly concerned with national advertisements promoting MA plan benefits and cost savings, which are only available in limited service areas or for limited groups of enrollees, as well as using words and imagery that may confuse beneficiaries or cause them to believe the advertisement is coming directly from the government. In addition, CMS receives complaints from beneficiaries and caregivers that highlight sales tactics designed to rush or push beneficiaries into enrolling into a plan.” We hope that this action means we all will see less of such ads.
We talk to more and more seniors each year who have been enticed by and are then misled by calling these 1-800 numbers. Folks end up on poor plans with poor benefits, high co-pays, deductibles, high maximum out-of-pocket amounts, and prescriptions not covered. Please use Ashford Insurance as your resource and call us with any questions you may have.
Header Photo by Nicola Barts from Pexels
Sonia Ashford, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance since 2005.