If you watch any television, you have probably seen the commercials that urge people over the age of 65 to call a toll-free number to discuss Medicare. They are encouraged to phone in and ask about extra benefits, free services, and even Medicare kickbacks in the form of Part B premium reductions. It all sounds too good to be true. Is it?
The answer is a resounding YES. Most of the claims these commercials make are too good to be true. While not technically fraudulent, their implied message does walk a fine line. One advertising series you may have seen in recent weeks features Jimmie Walker, who portrayed JJ on the TV show "Good Times" during the mid 1970s. If you aren't sick of seeing it yet, you can watch that commercial here.
Let's break down step-by-step what this advertisement implies, and then discuss what it actually means.
Part C Coverage
Jimmie starts out by talking about Part C coverage. "Part C" is another name for a Medicare Advantage Plan. Medicare Advantage plans are available to you based on the county where you live. They are administered by private insurance companies, who contract with the Federal government to manage your health coverage. So just to be clear, the commercial is offering enrollment in Medicare Advantage plans, and does not refer to benefits received by the Federal Government via Original Medicare. And when you call the 1-800 number on the screen, you are calling a company that brokers for Medicare Advantage insurance companies throughout the United States, so you are not going to be speaking to a Federal Medicare representative.
Eliminate Co-Pays
This commercial says that you can eliminate co-pays. It is true that some Medicare Advantage plans have $0 co-pays for certain benefits. For example; the plan you select might offer a $0 co-pay to visit your primary care doctor. But even so, you will still have a co-pay to see a specialist, be transported in an ambulance, have an X-ray, undergo an outpatient surgery, or have physical therapy, just to name a few. There are no Medicare Advantage plans in Minnesota* that offer $0 copays on every medical service. (*The exception would be if you are also on Medicaid, which is a federal public health insurance program for low-income beneficiaries. In Minnesota, Medicaid is called Medical Assistance.)
Prescription Coverage
This commercial states that your prescription coverage is included "at no extra cost." What it really means is that it is included at no extra premium: Nearly all Medicare Advantage plans include medical coverage plus prescription drug coverage under one combined monthly premium. However, there is almost always some cost associated with your filling your prescriptions. You may have a deductible, and it is likely you will also have co-pays on certain medications that you take. While the amount you pay out-of-pocket for your medications will depend on your own specific needs; as well as on the plan you choose; there is no Medicare Advantage plan available in Minnesota that covers all the prescriptions on its formulary "at no cost." That simply doesn't exist.
Dental Coverage
The commercial focuses heavily on dental coverage. Nearly all Medicare Advantage plans offer additional wellness services such as vision, routine (and sometimes comprehensive) dental, hearing, and even gym memberships. These extra benefits are included in the premium that you pay for your Part C coverage, and they are one of the reasons why Medicare Advantage plans are such a popular choice for many beneficiaries. But it is important to note that the scope of the benefits offered by Medicare Advantage plans; including dental coverage; will vary based on the amount you pay. In most cases, if you want comprehensive dental (such as coverage for dentures, extractions, and fillings as mentioned in the commercial) you will likely have a higher monthly premium, plus some cost sharing.
Meals and Transportation
Some Medicare Advantage plans do offer transportation and meals. However, these benefits are usually offered under very specific circumstances; usually after an inpatient hospital stay and for a very limited amount of time after discharge. Not all plans include them, and people in certain counties in the United States may find that there are no plans available to them that offer these services.
Money back on your Social Security benefit
This is the most misleading part of the commercial's message. Jimmie says that you may be able to get up to $1,700 back every year on your Social Security benefit payments. Jimmie is referring to a plan offering a "Medicare Giveback Benefit."
If you enroll in a plan that offers a "Medicare Giveback Benefit," you will have a reduction in your monthly Part B premium cost. In 2022, the standard Part B premium is $170.10, which is deducted automatically from your social security payment if you are receiving one. So, for example, if you enroll in a plan with a "Giveback Benefit" of $100 per month, your Part B premium cost will go down to $70.10 and since that amount is deducted from your Social Security check, your check will be higher.
Unfortunately, plans that offer Part B givebacks are generally not the plans that offer the most robust features or the lowest co-pays. This is because when an insurance company decides which benefits to offer each year, it must weigh its costs and make balancing choices. So, an insurer may drop or reduce another benefit (such as vision or hearing) to offer the premium reduction benefit. Or you might have significantly higher co-pays on this type of plan. In Minnesota, one of the most restrictive features of plans with the "Medicare Giveback Benefit" is that they don't offer prescription drug coverage. This alone makes these plans a non-starter for most beneficiaries in our state.
The bottom line About Medicare Kickbacks and Free Services.
When a spokesperson on a Medicare commercial implies that you can get comprehensive dental coverage, transportation, meals, $0 co-pays, plus money back on your social security, the reality is that you may be able to get some of these features, but not all of them. You must choose a plan whose coverage and benefits are best for your situation, and that will always be a give and take.
And remember: You might be drawn to some of the benefits these commercials highlight, only to find that they are not even available where you live. It is important to note that the Jimmie Walker commercial (and other similar commercials) run on a national basis. This should raise a red flag, since Medicare Advantage plans vary by county. There are over 3,000 counties in the United States. There are 87 counties in Minnesota alone. When a national firm speaks about benefits that MAY be available to you, their message is not usually relevant to the benefits that ARE available to you.
In summary, when you call a national telemarketing organization, you'll likely be speaking with someone who lacks an intimate knowledge of the plans in your local area. Instead, we strongly encourage you to work with an agent who operates out of the same state where you live. Not only can local agents help you understand which Medicare Advantage plans are available to you, but they can also discuss them within the context of the nuances of your own financial situation, your unique healthcare needs, and your personal set of priorities. What's more, your local agent can help you make an informed decision not only at the time you enroll, but on an ongoing basis as your needs change. And the services of a broker are available at no cost to you. Instead of falling for a pitch that's too good to be true, put your trust in someone you can get to know, and who can provide you relevant and helpful assistance.