Medicare Advantage marketing remains problematic.
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Remember in the fall of 2022, when no matter when you turned on the TV you would see former NFL players and celebrities pitching Medicare Advantage? Just call the number on your screen and get all the benefits you deserve. It seemed like commercials like that were playing everywhere.
Maybe it's because they were. According to KFF, 643,852 ads (9,500 per day) were placed on national TV and cable TV from October 1st (5 days before the open registration period begins) to December 7th (last day) .
It's no surprise that there are so many complaints about these commercials, about 40,000 in the first 11 months of 2021. As a result, the Centers for Medicare and Medicaid Services (CMS) has made several changes. One of the biggest is that starting January 1, 2023, federal regulators will have to approve commercials before they can be aired. Before this change, insurers had to prove that their ads met guidelines. (Maybe there were different guidelines in place.) In 2023, CMS will reject a third of ads, 1,000 of them between May 1st and December 1st. was rejected.
The Medicare Advantage open enrollment period ends on March 31st, but we've seen the impact of CMS' commercial rule changes. No need to reach for the remote control to set a speed record. But just because commercials are getting better doesn't mean we can let our guard down. Medicare Advantage plans are still trying to get people to pay attention and enroll in their plans.
New rules for marketing practices
In fall 2022, the U.S. Senate Finance Committee released a report on deceptive marketing practices in Medicare Advantage plans. CMS responded with new rules to address the issue. for example:
- Marketing works may not use the Medicare logo in a misleading manner.
- Ads must include the plan name.
- Superlatives such as “most” or “best” cannot be used to describe the benefits of a plan.
- Plans must submit marketing materials that could influence an individual's decisions, such as premiums, benefits, and cost-sharing details, to CMS for review.
I reviewed the marketing materials of the four largest plans mailed to Medicare-eligible individuals in our community. Here are some promotion points.
- There are three zero premium plans to draw attention to. (One of the headlines was in 1 1/2-inch-tall letters.) The fourth mentioned low-premium plans.
- Three listed zero out-of-pocket costs for Tier 1 and/or Tier 2 prescription drugs.
- They all advertised additional benefits such as a $1,500 dental benefit, free cleanings twice a year, gym memberships, over-the-counter medications, and a $1,500 refund benefit.
- The three emphasized the freedom to see the doctor of their choice.
As with any marketing piece, it's the things that aren't being said that you need to know before making a decision.
- Beyond free or low premiums, look at the cost-sharing of the services you need and your plan's out-of-pocket maximum (the maximum you can pay in a year). For example, one zero-premium plan included copayments for the primary care physician and specialist, as well as $295 per day for a six-day hospital stay, with a maximum copayment of $5,500.
- Check the cost of the medications you are taking. If you are taking a Tier 3 or Tier 4 drug, the zero copays for Tier 1 and Tier 2 are not very helpful.
- Find out more about additional benefits. Your gym membership may be located in an inconvenient facility. A $1,500 dental allowance sounds great until you find out he has 50% coinsurance for the dentures he needs.
- There are limits to your freedom to choose your doctor. Some may be out of network, so you should choose a Preferred Provider Organization (PPO) plan. You'll probably end up paying the doctor more. This is often coinsurance for a portion of the cost. And finally, out-of-network physicians are not obligated to see patients outside their contracted network.
Much of what you see and hear about Medicare can be misleading or completely wrong. Please research. Check all details. Be a smart Medicare shopper.
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