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Advantage Plan Marketing Oversight

Today’s video shares information from a September article in the Wall Street Journal on Medicare Advantage Marketing Oversight. Because we are currently in the Medicare Annual Enrollment period which lasts through December 7th for new coverage beginning January 1, 2023, this information is very relevant. The article reported that the Center for Medicare and Medicaid Services (CMS), the agency with regulatory authority over Advantage Plans, received 41,136 consumer complaints about Medicare Advantage Plan marketing last year. The article suggests consumers complained because Advantage Plan marketing was misleading. We don’t know what a reasonable number of complaints would be but it was reported that this was a 165% increase over 2020 which seems quite significant.

As a result, regulatory scrutiny of Advantage Plan ads has been increased which we feel is good for consumers. Nevertheless, if the pitch seems “too good to be true,” then perhaps it is.

Remember, when Joe Namath and others advertise a “free” phone call please know that just about any one you contact has an objective of selling you something.

Also remember that not all Advantage Plans are the same. In my zip code, one can choose among 29 plans! The lowest in-network out-of-pocket maximum is $5,900; the highest is $7,550. The highest out-of-network out-of-pocket maximum among the plans is $10,000. Clearly, television ads do not focus on these numbers.

An HMO by definition has a limited network and all Advantage Plans, including PPO products, have some aspects of managed care products, a network, rules and more aggressive utilization review.

Original Medicare offers more freedom to choose providers without the added complexity of a managed care environment. On the other hand, Advantage Plans can enhance benefits in ways that original Medicare cannot. But let’s be serious about Advantage Plan offers of dental and vision coverage, home visits, transportation and meals. These types of benefits will always be limited.

Our advice is always, shop around, be careful about those pitches, and do your homework. You don’t want buyer’s remorse!

Thanks for watching and please spread the word.