The Center for Medicare and Medicaid Services (CMS) is the federal agency that has oversight regarding Medicare Advantage plans sold in the USA.
In 2021 CMS received over 41,000 complaints from consumers about their Advantage plan coverage. In 2020 the number of complaints was approximately 13,000. The vast majority of complaints related to misleading marketing. Watch just about any Medicare Advantage television advertisement the last two years during the annual open enrollment season (October 15th-December 7th) and it is not hard to understand why so many individuals are upset.
The old saying “if it seems too good to be true it probably is” comes to mind. Technically speaking, everything mentioned in these television ads is likely true, but what is not mentioned in the ads is much more important when attempting to find the best deal.
Rarely mentioned in television ads is the fact that the average annual out of pocket maximum for all Advantage plans in the USA is $7550! Some plans offer lower out of pocket maximums, others higher, but the advertisements never seem to mention the amount. They are happy to mention dental and vision benefits, meals and transportation, but never seem to mention just how limited these benefits typically are. Worse, they never seem to mention just how few doctors, specialists, and hospitals are in-network.
Many of the Advantage plan advertisements offering free food, rides to the doctor, dental coverage, vision, or money added back to your Social Security never seem to mention that to qualify for such benefits your income must be at or near the federal poverty level. The television ads encourage you to call to see if you qualify, knowing full-well that most individuals that call will never qualify. The goal of the advertiser is to get you to call and sell you one of their other Advantage plans or supplement plans once it is determined that you don’t qualify for the low-income plans.
The vast majority of Medicare Advantage plans are HMO policies. By definition all HMO plans have limited provider networks. HMO plans are managed care products and have aggressive utilization review procedures. Want to see a specialist? You must first get the ok from your primary doctor. If and when you get the ok from your doctor and insurance company, plan to wait quite a while for a specialist appointment, as specialists are typically few and far between.
If you want to avoid all the headaches of an Advantage plan it is best to buy a Medicare supplement plan instead, specifically the Senior Security G plan from Blue Cross and Blue Shield of Arizona. See any Medicare doctor or hospital in the country (96% of all doctors/hospitals) no specialist referrals, freedom to move out of state and keep the policy and have a $50,000 lifetime benefit in medical coverage while traveling out of country. Supplement plans are very reasonably priced. The maximum out of pocket with the G plan is around $200 a year, not thousands of dollars like most HMO Advantage plans.
If you enroll in a Medicare Advantage plan you are locked in for the year, you can’t switch policies. (In rare situations you may switch.) With Medicare supplement plans you may switch policies any time of year.
If you purchase a Medicare supplement plan you must also purchase a Part D prescription plan, as prescriptions are not covered on supplement plans. Prices range from $10-$50 a month typically. The national average is around $35.
If you must enroll in a Medicare Advantage plan the Blue Cross and Blue Shield of Arizona Advantage plans are a smart choice. BCBSAZ is, and has always been, the largest, non-profit insurance company in Arizona that shoots straight, avoiding all the gimmickry so common with many television advertisers today.