Medicare Advantage marketing remains to be problematic

Do you remember fall 2022? Former NFL players or celebrities promoted Medicare Advantage with words like: Just call the number in your screen to get all the advantages you deserve. It appeared like these commercials were in all places.

Maybe that is because they were. According to KFF, there have been 643,852 advertisements (9,500 per day) on national and cable television between October 1 (five days before the beginning of the open enrollment period) and December 7 (the last day).

It’s no surprise that there have been many complaints about these commercials – almost 40,000 in the primary 11 months of 2021 per KFF. This prompted the Centers for Medicare & Medicaid Services to make some changes. One of the largest: Beginning January 1, 2023, federal regulators must approve commercials before they go on air. Before this variation, insurers were required to certify that advertisements met guidelines. (Maybe that they had different policies.) In 2023 CMS rejected a 3rd of the adswith 1,000 of those rejections occurring between May 1 and December 1.

The open enrollment period for Medicare Advantage ends March 31, and CMS industrial rule changes have had an impact. Viewers do not have to set speed records by reaching for the handheld remote control. But simply because commercials have improved does not imply you must let your guard down. Medicare Advantage plans are still attempting to get people to listen and enroll for his or her plans.

New rules for marketing practices

In fall 2022, the U.S. Senate Finance Committee released a report on deceptive marketing practices for Medicare Advantage plans. CMS responded with recent rules to handle the issues. For example:

• Marketing articles must not use the Medicare logo in a misleading manner. (I saw a modified Medicare card in a recent ad. It has the identical blue header with a curved edge, “Medicare” in white letters, and a red bar at the underside. No text in the center.)
• Advertising must contain the plan name.
• There may be no superlatives reminiscent of “most” or “best” to explain the advantages of the plan.
• Plans must submit marketing materials to the CMS for review that will influence a person’s decision, including details about premiums, advantages, and price sharing.

I reviewed the marketing materials from 4 of the biggest plans that were mailed to Medicare-eligible people in my community. Here are a few of the promotional points.

• Three well-known zero premium plans available. (One heading contained letters 1½ inches high.) The fourth heading mentioned low-premium plans.
• Three listed $0 copays for Tier 1 and/or Tier 2 prescribed drugs.
• They all offered additional advantages, reminiscent of a $1,500 dental subsidy, two free dental cleanings a yr, gym memberships, over-the-counter medications and a $1,500 reimbursement profit.
• Three emphasized plan members’ freedom to see any doctor of their selection.

As with any marketing piece, you could know what is not being said before making a call.

• Go beyond zero or low premiums and have a look at cost-sharing for the services you would like, in addition to the plan’s out-of-pocket maximum (essentially the most you might potentially pay in a yr). For example, a no-premium plan provided copays for the first care physician and specialists, together with $295 per day for six days of hospitalization and a maximum out-of-pocket amount of $5,500.
• Find out about the price of the medications you’re taking. Zero dollar copays for Tier 1 and Tier 2 don’t do much good in the event you’re taking Tier 3 or 4 medications.
• Find out about the small print of the extra services. A gym membership could also be at a facility that’s inconvenient for you. A $1,500 dental subsidy sounds great until you realize there may be a 50 percent coinsurance for the dentures you would like.
• Your freedom in selecting a physician is subject to restrictions. There is a possibility that some are outside the network. So you’ve to decide on a Preferred Provider Organization Plan or PPO for brief. You will probably pay more for these doctors. In many cases, that is coinsurance, a percentage of the price. Finally, out-of-network physicians in Medicare Advantage PPO plans are usually not required to treat patients who are usually not of their contracted networks.

Much of what you see and listen to about Medicare could also be misleading or outright false. Please investigate. Get all the small print. Be a sensible Medicare shopper.