How to spot misleading Medicare Advantage ads

Dear Savvy Senior: I am currently enrolled in Original Medicare, but was considering switching to a Medicare Advantage plan during the open enrollment period. Many of the Medicare Advantage ads I’ve seen offer many additional benefits beyond what traditional Medicare offers and no monthly premiums. What are your thoughts? – Consider a switch

Dear Considering: Be alert for Medicare Advantage ads on TV, radio, social media, and in promotional mail. While many of these ads may tout free vision, hearing, dental and other benefits with zero monthly premiums, they aren’t always what they claim to be.

Medicare Advantage, also known as Medicare Part C, consists of government-approved health plans sold by private insurance companies that you can choose instead of original Medicare. The vast majority of Advantage plans are managed care policies, such as HMOs or Preferred Provider Organizations that require you to get your care at a network of doctors in a geographic area. You can apply for one of them during the open enrollment season from October 15th to December 7th.

Affordable plans have exploded in popularity in recent years as insurers have flooded the airways with ads, often by celebrity guns, promoting low-cost options with lots of added benefits.

But be aware that the federal government considers many of the claims in these ads to be false and misleading. Some advertisements imply that the Centers for Medicare and Medicaid Services endorses or prefers a specific plan. Others promise more savings than you actually 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.

In September, the US Department of Health and Human Services began cracking down on these ads, but you should still practice self-defense. Here are some tips to help you make a good decision.

>> Cover your needs: When evaluating Advantage plans, make sure the ones you’re considering cover the doctors you love and the health care facilities you typically go to for your care. Also, make sure all prescription drugs you take are on the drug plan’s formulary.

To help you compare plans, a good first step is to call the doctors’ offices you use and find out which Advantage plans they accept and which they recommend. Then go to the Medicare Plan Finder tool at Medicare.gov/plan-compare to compare plans in your area.

>> Understand the details: Some Advantage plans do not promote monthly premiums, but the reality is that you are still responsible for your original Medicare costs, including the Part B premium, as well as deductibles and copayments for covered services. In addition, you may have to pay more out of pocket if you see an out-of-network doctor. Also, if the plan is an HMO, it generally does not cover out-of-network non-emergency care, so one person may be responsible for the full cost. A PPO, on the other hand, allows people to go out of network, but they generally have to pay more to do so.

>> Do some digging: Many Advantage plans offer free vision, hearing and dental benefits not covered by traditional Medicare, but these benefits are often limited. For example, a plan that offers free dental coverage may only cover 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. Know the details of your coverage so you’re not surprised later.

>> Ask for help: Contact your local State Health Insurance Assistance Program, known as SHIP, at ShipHelp.org or call 877-839-2675. These are nonprofit programs that provide one-on-one, unbiased Medicare counseling and assistance.

You can also report any erroneous Medicare Advantage claims to the Medicare Senior Patrol Resource Center at SMPResource.org or by calling 800-447-8477.

Jim Miller is a contributor to NBC-TV’s “Today” program and the author of “The Savvy Senior.” Send your questions to Savvy Senior, PO Box 5443, Norman, OK 73070; or visit savvysenior.org.