Medicare Advantage Marketing Still Is Problematic

Remember the fall of 2022? No matter when you turned on the TV, you saw a former NFL player or celebrity pitching Medicare Advantage. Just call the number on your screen to get all the benefits you deserve. It seemed as though those commercials were everywhere.

Maybe that’s because they were. According to KFF, there were 643,852 ads (9,500 per day) on national and cable television between October 1 (five days before the Open Enrollment Period began) and December 7 (the last day).

It’s no surprise that there were many, many complaints about these commercials, almost 40,000 in the first 11 months of 2021. That led the Centers for Medicare and Medicaid Services (CMS) to make some changes. One of the biggest: As of January 1, 2023, federal regulators must approve commercials before they go on air. Prior to that change, insurers had to certify that the ads met the guidelines. (Perhaps they had a different set of guidelines.) In 2023, CMS rejected one third of the ads, with 1,000 of those rejections between May 1 and December 1.

The Medicare Advantage Open Enrollment Period ends March 31 and I have seen the impact of CMS’ rule changes for commercials. I don’t have to set speed records reaching for the remote. But just because the commercials have improved doesn’t mean you can let down your guard. Medicare Advantage plans are still trying to get people to pay attention and sign up for their plans.

New rules for marketing practices

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

• Marketing pieces cannot use the Medicare logo in a misleading way.
• Advertisements must include the plan name.
• There can be no superlatives, like “most” or “best” to describe the plan’s benefits.
• Plans must submit to CMS marketing materials, which can influence a person’s decision, including details about premiums, benefits, and cost sharing, for review.

I reviewed marketing materials from four of the largest plans sent in the mail to Medicare-eligible individuals in my community. Here are a few of the promotional points.

• Three noted zero-premium plans available. (One headline was in letters 1 ½ inches tall.) The fourth mentioned low-premium plans.
• Three listed zero copays for Tier 1 and/or Tier 2 prescription drugs.
• All of them promoted extra benefits, such as a $1,500 dental allowance, two free cleanings a year, gym membership, over-the-counter medications, and a $1,500 giveback benefit
• Three highlighted the freedom to see any doctor they choose.

As with any marketing piece, it is what’s not said that you need to know before making a decision.

• Go beyond the no- or low-premium and check cost sharing for the services you need and the plan’s out-of-pocket maximum (the most you could possibly pay in a year). For example, one zero-premium plan had copays for the primary doctor and specialists, along with $295 per day for six days of hospitalization, and a $5,500 out-of-pocket maximum.
• Check out the costs for the drugs you take. Zero copays for Tier 1 and Tier 2 don’t do much good if you take Tier 3 or 4 medications.
• Investigate the details of the extra benefits. Gym membership may be at a facility that is not convenient. A $1,500 dental allowance sounds great until you discover that there’s a 50% coinsurance for the dentures you need.
• There are restrictions on your freedom to choose your doctors. Chances are some will be out-of-network so you must elect a preferred provider organization (PPO) plan. You likely will pay more for those doctors. In many cases, this will be a coinsurance, a percentage of the cost. And, finally, out-of-network doctors have no obligation to see any patient who is not in their contracted networks.

So much of what you see and hear about Medicare can be misleading or flat out wrong. Do your research. Get all the details. Be a smart Medicare shopper.