In a recent TikTok video, a nurse has issued a PSA to her viewers, advising against enrolling in Medicare Advantage plans.
The video, posted by Christy (@christyprn) on Nov. 21, has amassed over 128,900 views, sparking a lively debate among commenters about the pros and cons of these private health insurance alternatives.
In the video, Christy recounts encountering a billboard on her way home: “I saw a big billboard that said, ‘Enroll in a Medicare Advantage plan, and you’ll get a free gym membership!’ and it reminded me to give you guys your yearly reminder to not enroll in a Medicare Advantage health insurance plan.”
She explains, “When those Medicare health insurance plans are managed by the government, that is just called Medicare or some of us call it traditional Medicare. However, a while back, the government started allowing private insurance companies to distribute these plans as well. These are called Medicare Advantage plans.”
Christy goes on to express her reservations about these private insurance plans, citing concerns that they may deny crucial healthcare services that traditional Medicare would cover, “A lot of health care workers really don’t like these Medicare Advantage plans because they tend to deny a lot of really important care that traditional Medicare would have covered,” she claims.
However, while emphasizing the need for careful consideration, the TikToker gives out a disclaimer: “There may be some instances where a Medicare Advantage Plan offers some additional benefit that might be more beneficial to a patient than traditional Medicare.”
Since it was posted, the video has sparked a lively debate in the comments section, with healthcare workers and viewers sharing their experiences and opinions.
Some echoed Christy’s concerns, with one commenter saying, “I work in outpatient care, and the Medicare advantage plans are the worst. We can’t get anything covered.”
“Thank you, say it louder. Advantage plan are thieves,” a second added.
“RN here. Amen sister. It will bankrupt them,” a third wrote.
However, others disagreed, recounting their positive experiences with their plans.
“My father was on different Medicare Advantage plans here in NC. They worked out great for him. No extra monthly cost and more docs to choose from,” one such commenter wrote.
“Medicare Advantage has worked great [for] me. My Dr’s med group totally has their act together,” a second claimed.
“No doctors in my area accept regular Medicare. I can only use it at urgent care clinics,” a third commenter remarked.
The Daily Dot has reached out to Christy via TikTok comment.
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If you watch any amount of television the old-fashioned way—live—it would be hard not to notice the onslaught of Medicare ads. Faded comedy stars and sports heroes flood the airwaves each year between October 15 and December 7, the Medicare Annual Enrollment Period (AEP). During nearly every commercial break, seemingly low-budget, high-pressure ads urge Americans over 65 to check their options and make sure they’re getting all the benefits to which they’re entitled.
With 65 million Americans on Medicare, it’s no wonder that health insurers and brokers are falling all over themselves to reach Medicare beneficiaries. The AEP is the only time many people on Medicare have the option to make coverage changes, such as joining or switching Medicare Advantage (MA) or prescription drug plans or moving between Original Medicare and MA.
Those ads aren’t just annoying; historically, many of them have been misleading, according to an analysis by KFF. That may be changing this year thanks to new Medicare rules.
Inundating, Misleading Ads KFF analyzed 650,000 airings of Medicare ads that appeared on air between October 1 and December 7, 2022. While the ads promoted all types of Medicare plans, including Part D prescription drug plans and Medigap supplemental plans, MA ads dominated with 85% of all airings.
More than one-quarter (27%) of the MA ads showed images of government-issued Medicare cards or images that closely resembled the official Medicare card. Most (83%) ads sponsored by brokers or other third parties pointed people to call a private Medicare hotline rather than the official Medicare line (800-MEDICARE). More than 50,000 airings used messaging that warned viewers they might be missing out on benefits, suggesting their current coverage could be incomplete.
The vast majority of MA ads (92%) focused on extra benefits, such as dental, vision, hearing, and prescription drug benefits, which most enrollees can get. However, 67% of third-party or broker ads promoted financial benefits such as getting a rebate for Part B premiums known as the “give back” benefit despite just 17% of plans offering such a rebate.
KFF also conducted focus groups to understand how consumers experience the process of choosing a Medicare coverage. The research found that many Medicare beneficiaries were unclear on their Medicare coverage options and the trade-offs between them. Focus group participants noted feeling overrun with often-misleading ads. Despite—or perhaps because of—the abundance of messages, participants reported feeling confused or unclear about the options.
At a September briefing on KFF’s findings, Lindsey Copeland, director of federal policy at the Medicare Rights Center, a national nonprofit organization, said that her organization often receives calls about misleading Medicare marketing. Copeland said that consumers often report feeling unsure who to trust. They may feel pressure to take action based on TV ads or direct mail, even if they are happy with their current coverage. Some report being confused about who is sending them official-looking mail and questioning if offers seem too good to be true are legitimate.
According to Copeland, 20% of calls to the Medicare Rights Center’s helpline about misleading marketing are from people who were enrolled in a plan without their knowledge or consent. Callers report thinking they were talking with Medicare or believing they were providing information to a broker but not consenting to switch plans. They may only realize what has happened weeks later when paperwork arrives, by which time they have little or no recourse. Other callers say they switched willingly but learned their decision was based on inaccurate or incomplete information, and that they failed to understand what they might be giving up.
New Rules To Protect Consumers New CMS rules may be shifting the nature of Medicare advertising. Advertisers can no longer use the Medicare logo, name, or the official Medicare card in a way that could imply that the ads are coming from the official Medicare program. Broker ads will need to specify which plans they are selling and benefits that aren’t available to everyone must be clearly identified as such.
“We are really trying to reign in misleading marketing practices,” Meena Seshamani, M.D., Ph.D., director of the Center for Medicare, said in an interview.
Seshamani said the agency is instituting what she calls common-sense rules and considering the experience of Medicare beneficiaries who are bombarded by ads and confused about their options, which include Medicare Advantage, Original Medicare, and Medicare prescription drug plans.
“These are all important pieces of the Medicare program; they are all important options for people to have,” she said. “But if they are getting confused and if they’re getting misled, then the program’s not working for them.”
In the KFF briefing, CMS administrator Chiquita Brooks-LaSure said that in response to skyrocketing complaints over the last couple of years, the agency will review all television, radio, and web-based ads in advance to make sure they meet the requirements.
“These protections that we put forward are really spurred in large part by the feedbackmthat we have gotten through partners and from the people we serve,” LaSure said.
“What we are focused on is just making sure that people have access to accurateminformation.
Terri Swanson, president of Medicare for Aetna, a CVS Health company with nearly 11mmillion Medicare members, is positive on the new rules.
“We want to make sure Medicare beneficiaries are getting the information they needmand feel supported in their experience,” Swanson said in an interview. “That’s whymAetna fully supports CMS oversight of marketing practices, and we are committed tompartnering with CMS to ensure that beneficiaries receive clear, correct and helpfulminformation about their Medicare plan options.”
Swanson encourages Medicare beneficiaries to take the time to learn about their options and understand what plan is right for them. She recommends starting with a few
basic questions, such as does the plan fit your budget? Are your favorite doctors,,hospitals, and pharmacies in the plan’s network? And does the plan cover your specificmprescriptions?
“As with all things in life, one size does not fit all,” she said. “Your team of doctors and healthcare professionals can also help you understand your health needs, which is important when deciding on a plan.”
According to Seshamani, CMS’ objective is similarly focused on consumers’ needs:
“How can we make sure that people are getting the information that they need, so that they can make the best decision for them?”
Author: Deb Gordon I am co-founder and CEO of Umbra Health Advocacy and co-director of the Alliance of Professional Health Advocates. I’m the author of The Health Care Consumer’s Manifesto: How to Get the Most for Your Money, based on research I conducted as a Senior Fellow in the Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government. For nearly a decade, I served as Chief Marketing Officer for a health plan during Massachusetts health reform and the ACA implementation. I am an Aspen Institute Health Innovators Fellow and an Eisenhower Fellow, for which I traveled to Australia, New Zealand, and Singapore to explore the role of consumers in high-performing health systems. I hold a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School.
As you approach age 65, you’ll have some decisions to make about medical coverage. On one hand, you can enroll in Medicare. But you may be tempted to choose another option instead: a Medicare Advantage (MA) plan instead. If you’ve seen the advertisements for MA plans, you might think they’re more cost-effective and comprehensive than Medicare. But according to Keith Armbrecht, Founder of Medicare education company, Medicare on Video, that’s not necessarily true.
“I would never choose a Medicare advantage plan,” he says in a YouTube video entitled “Why Medicare Advantage Is The Worst Choice For Seniors.”
Here’s why he’s not a fan of these plans.
What is a Medicare Advantage plan?
Medicare Advantage plans are alternative insurance plans to Medicare, and they’re offered by Medicare-approved private companies. These plans are sometimes called “Part C” or “MA,” and they include Medicare Part A (hospital insurance) and Part B (medical insurance).
Those interested in MA have more than 40 different plans to choose from. The main
reasons to explore them include:
The potential for lower premiums compared to Medicare. In 2022, the average premium was $58, according to 2022 data from the U.S. Senate Committee on Finance.
Out-of-pocket costs may be capped. In 2023, the maximum was $8,300 for approved services.
Most plans include dental, vision, hearing and fitness benefits.
That being said, there are a few downsides to Medicare Advantage plans. Here are some important things to consider before locking into an MA plan.
Limited choice
If you opt for an MA plan, your choice of doctors can be limited and you’re likely to face obstacles in getting approved for procedures or seeing specialists. “The primary reason I would absolutely choose original Medicare and would never choose Medicare Advantage is because I want control over what I do,” says Armbrecht. With an MA plan, he warns, you can face wait times of “weeks, even months,” to get referrals or have procedures authorized.
You’re typically limited to doctors in the plan network and service area, as well,
according to the government’s Medicare website.
Deceptive marketing
The Medicare Advantage plan industry has a history of deceptive practices. In 2022, the Majority Staff of the U.S. Senate Committee on Finance found that Medicare beneficiaries were being inundated with aggressive marketing tactics, false and misleading information and overall predatory marketing from MA providers. According to the report, deceptive Medicare Advantage marketing practices are, “widespread, not isolated events.”
According to a 2022 review from the New York Times, four out of five of the largest MA providers (UnitedHealth, Humana, Elevance and Kaiser) have faced federal lawsuits for fraud and at least eight providers overbilled, according to the U.S. Department of Health and Human Services Office of the Inspector General.
Denied claims
Multiple studies have shown MA plans have a pattern of denying claims that should be covered.
A 2022 review from the Inspector General’s office found that MAs denied 13% of prior authorization requests that met Medicare coverage rules. Essentially, these claims would have been approved under original Medicare. The most commonly denied requests were imaging services, stays in post-acute facilities and injections.
Go to the source
“Medicare is probably the only government program that does exactly what it’s supposed to do and does it very well,” says Armbrecht. In other words, original Medicare is likely your best choice. If you’re nearing 65 and considering your options, you can visit Medicare.Gov for accurate and up-to-date information so you can make the right decision for your health insurance needs.
Seniors who opted for private Medicare insurance plans should not be shy about pushing back on denials for pre-authorizations, according to a new study.
Of the 35 million requests by Medicare Advantage enrollees seeking prior authorization for healthcare services or medications in 2021, two million of those requests were fully or partially denied, according to a new analysis from the Kaiser Family Foundation (KFF), a nonprofit organization.
The results raise flags that the approval process may create unnecessary obstacles for patients to receive medical care and underscored that seniors may want to spend more time shopping around for these popular plans to avoid these hassles.
“The high frequency of favorable outcomes upon appeal raises questions about whether a larger share of initial determinations should have been approved,” Jeannie Fuglesten Biniek, KFF’s associate director, program on Medicare Policy, and Nolan Sroczynski, a KFF data analyst, wrote.
“It could reflect initial requests that failed to provide necessary documentation. In either case, medical care that was ordered by a healthcare provider and ultimately deemed necessary was potentially delayed because of the additional step of appealing the initial prior authorization decision, which may have negative effects on beneficiaries’ health,” the authors concluded.
Don’t Take No for an Answer
The pre-authorization hoop primarily impacts people enrolled in Medicare Advantage plans, a privatized, managed-care version of the traditional Medicare program.
In 2022, virtually all Medicare Advantage enrollees (99%) were enrolled in a plan that required prior authorization for some services. Most commonly, higher-cost services, such as chemotherapy or skilled nursing facility stays, require prior authorization, according to KFF’s study, which reviewed data from 515 Medicare Advantage contracts representing 23 million Medicare Advantage enrollees.
Medicare’s basic, original Part A (hospital insurance) and Part B (medical insurance) cover obvious things you expect from health insurance: hospital stays, appointments with your doctor when you’re sick, ambulance services, flu shots. But the government’s healthcare program for Americans 65 or older also pays for many things that might surprise you.
If you’re on Medicare or are approaching that time of your life, you’ll want to be aware of these 10 Medicare benefits that enrollees often don’t know about and that can keep you from dipping into your savings.
1. Annual ‘Wellness Visits’
Once you’ve had Medicare Part B coverage for a year, you’ll get what’s called an annual wellness visit with your doctor, who will take routine measurements, such as your height, weight, and blood pressure, and review your medical history. You’ll fill out a “Health Risk Assessment” questionnaire to identify risk factors — so you and your doctor can work on keeping you healthy. Medicare says the appointments also can include “detection of any cognitive impairment.” That means your physician will be on alert for signs of Alzheimer’s or similar ailments.
2. Obesity Counseling
Obesity causes many illnesses and can make frail older bodies much weaker. Diabetes and heart disease rates skyrocket for those who are overweight or obese. Joint and bone diseases are easier to manage at healthy weight levels. If you have a Body Mass Index (BMI) reading of 30 or more, Medicare will cover face-to-face counseling sessions in a primary care setting (like a doctor’s office) to help you bring your weight down to a healthier level.
3. Help to Quit Smoking
If you’re a smoker, Medicare can help you kick the habit. Letting go can be tough, especially if you’ve been a lifetime smoker. To help you break your nicotine addiction, Medicare will pay for eight in-person counseling sessions per year. But note that Medicare’s drug coverage will not pay for stop-smoking products sold over the counter at drugstores, like nicotine patches, lozenges, and gum.
4. Some Hearing Exams
Basic Medicare usually won’t pay for hearing aids or routine hearing tests. But it may cover a hearing exam if your doctor says it’s medically necessary. Hearing is related to balance. When a senior is having balance issues, a physician may want to check the ears to see if there’s an inner ear problem requiring medical treatment.
5. Hospice Care
Hospice care comprises a host of treatments at the end of a person’s life. Medicare will pay for a long list of hospice services, including nursing care, and grief and loss counseling for the patient and family. Hospice coverage applies when a Medicare recipient has been given six months or less to live and has agreed to forgo further attempts at a cure. Medicare-certified hospice care usually takes place where you already live — whether that be at home or in a nursing home. You can also receive hospice care in an inpatient facility. However, it’s important to note Medicare doesn’t cover your room and board, though it may pay for a short-term stay at a hospice facility if your hospice team determines you need that. If you’re dealing with any other health issues not related to your terminal illness, that should also still be covered by Medicare. But the government’s Medicare site points out that’s fairly unusual. Once you select hospice care, the hospice benefit typically covers everything you need.
6. Counseling for Alcohol Problems
Much like smoking, alcohol abuse can have seriously negative effects on the wellness of an older person. Medicare provides alcohol misuse screening and treatment free of charge. It covers one screening per year and up to four brief counseling sessions if the reviewing physician believes a patient needs help.
7. Disease Screenings
Medicare covers screenings for numerous diseases as part of its preventive services. Medicare will pay for testing to detect HIV and other STDs, diabetes, glaucoma, breast and cervical cancer, colon and prostate cancer, and heart disease. Patients with histories of smoking can get an annual lung cancer screening, and Medicare also covers annual screenings for depression and other behavioral health issues that are a concern for seniors.
8. Special Footwear for Diabetes
One of the least-known Medicare benefits is its allowance for specialized shoes for people with diabetes. The disease can cause poor or abnormal circulation in the feet, and a lack of proper treatment can result in the need for amputation. Another risk is diabetic neuropathy, which can damage nerve endings in the feet. Diabetic footwear helps regulate circulation and reduce the danger of neuropathy. Medicare will pay for one pair of custom-molded shoes and inserts and a pair of extra-depth shoes if they’re prescribed and provided by a podiatrist or other qualified health professional. Your insurance will also cover another two pairs of inserts for your custom-molded shoes and three pairs of inserts for extra-depth shoes each calendar year.
9. Wheelchairs and Scooters
Wheelchairs and mobility scooters are important tools to help those with debilitating conditions lead normal lives. Medicare will pick up the cost under certain circumstances. The wheelchair or scooter must be considered medically necessary. Your doctor would need to certify that you are unable to walk without difficulty. The physician would be required to write a prescription for the vehicle or wheelchair after giving you an exam.
10. A Walk-In Bathtub (Maybe)
A walk-in tub can help those with joint problems or other issues that make climbing into a traditional bathtub difficult or impossible. Medicare may help with the cost of a walk-in tub, even though the tubs are not on the list of “durable medical equipment” that Medicare will cover, including wheelchairs, oxygen equipment, and hospital beds. In order for you to obtain coverage, your doctor would have to attest that a walk-in tub is an absolute medical necessity. Medicare wouldn’t provide assistance upfront — after you buy the tub, you’d submit the bill for possible reimbursement. But there’s no guarantee that you’ll get your money back.
