Table of Contents:
- Myth #1: All Medicare Advantage Plans Offer Additional Benefits
- Myth #2: $0-Premium Medicare Advantage Plans Are Free
- Myth #3: All Seniors Have Access to Medicare Advantage
- Get the Facts on Medicare Advantage
Many state and federal agencies do their best to protect consumers from misleading advertisements. Whether they’re selling cars or health insurance policies, advertisements that are deceptive or misleading in order to make their product more appealing or prey upon the viewer’s lack of information are prohibited.
That doesn’t mean commercials always tell the whole story. Tune in to a TV spot for Medicare Advantage and you may still believe a number of common Medicare myths afterwards. Carriers don’t lie about their plans, but it’s hard for a 30-second commercial to convey all the nuances of Medicare Advantage coverage.
Here are three common Medicare myths that vague advertisements may not help debunk. If you’ve done most of your research from the couch, it’s entirely possible you accept one or more as fact.
Myth #1: All Medicare Advantage Plans Offer Additional Benefits
Fact: Medicare Advantage Plans and the Services They Cover Differ from Plan to Plan
One of the much-touted benefits of Medicare Advantage plans is the access they provide to services that Original Medicare (Parts A and B) does not cover. Commercials emphasizing coverage that works for a wide variety of eligible persons can obscure the fact that the menu of available benefits varies from plan to plan and carrier to carrier.
Here’s an overview of the Medicare Advantage landscape in 2021 and the benefits carriers are providing to policyholders:
- 98% of Medicare Advantage plans offer telehealth services to connect policyholders with providers throughout the COVID-19 pandemic
- 92% offer coverage for at least some dental services like routine cleanings or dentures
- 91% offer coverage for at least some vision services, including routine eye exams and glasses
- 89% offer some level of prescription drug coverage
Other benefits are far less common, though advertisements may make them sound like standard features of Medicare Advantage:
- 55% of plans offer meal benefits like deliveries or nutrition education
- 36% offer transportation services, such as shuttles to and from the doctor
- 6% offer reimbursement for bathroom safety fixtures
- 6% offer in-home support services
While the majority of Medicare-eligible individuals have access to plans offering some extra benefits, certain restrictions may apply. For example, a plan may reserve access to certain benefits for specific subgroups or require policyholders to obtain an authorization from their primary care provider to take advantage of covered services.
Myth #2: $0-Premium Medicare Advantage Plans Are Free
Fact: $0-Premium Medicare Advantage Plans Charge $0 In Addition to Your Part B Premium
$0-premium Medicare Advantage plans make for eye-catching advertisements. They can also mislead consumers who neglect to do extra research. The very term “$0-premium plan” is misleading because it ignores the fact that all Medicare Advantage policyholders are responsible for paying the Medicare Part B premium ($148.50/month in 2021).
Carriers have broadened access to $0-premium plans in recent years, but more traditional options remain popular. In 2021, the average Medicare Advantage policyholder pays a monthly premium of $21 in addition to their Part B costs.
What’s more, premiums are just one of the expenses associated with Medicare Advantage coverage. On average, policies with lower premiums tend to present policyholders with higher rates for out-of-pocket costs like copays or coinsurance.
Myth #3: All Seniors Have Access to Medicare Advantage
Fact: Medicare Advantage Plans are Available in All But 82 US Counties
As Medicare Advantage plans grow more popular, the menu of options is expanding for seniors across the nation. In 2021, 99% of Medicare-eligible seniors have the opportunity to enroll in Medicare Advantage and most have several options to choose from. There are, however, 82 counties where health insurance carriers do not offer Medicare Advantage.
Get the Facts on Medicare Advantage
The Centers for Medicare and Medicaid Services (CMS) recognizes that eligible individuals may be vulnerable to misinformation and that navigating the health insurance marketplace is overwhelming under any circumstances. CMS offers its Plan Finder Tool to help seniors easily compare plans in their area. For more answers to your questions, check out the library of resources on Marigold Medicare.
Additional data and cost information adapted from Forbes and the Kaiser Family Foundation
Half-Truths and Medicare Advantage Commercials, 2020. Forbes.
Medicare Advantage 2021 Spotlight: First Look, 2020. KFF.