Opinion: Be wary of misinformation on Medicare Advantage plans

John Ray

With Medicare’s annual enrollment period here, seniors are bombarded with ads and calls promoting Medicare Advantage plans, often emphasizing extra perks like vision, dental and gym memberships. Unfortunately, much of this information can be misleading or incomplete.

Choosing the wrong Medicare Advantage plan – or any plan – based on inaccurate information can have long-term consequences. For some, it may even limit future options for health care coverage, especially if they develop a chronic condition.

This is a call for vigilance: Selecting a Medicare plan should be based on well-researched, reliable information tailored to your unique needs.

Medicare Advantage (Part C) bundles Medicare parts A and B and often adds other benefits. However, many enrollees are unaware that joining Medicare Advantage could make it difficult, if not impossible, to return to original Medicare with a Medicare supplement (medigap) policy, according to a fact page on MedicaidInteractive.org.

This can be especially problematic if you develop a chronic condition, which could affect your eligibility for medigap. In most cases, individuals only have a limited time when they first qualify for Medicare to enroll in a medigap plan without having to answer medical questions. If they later decide to leave a Medicare Advantage plan and rejoin original Medicare, they could face medical underwriting, making it challenging or costly to obtain medigap coverage – if they qualify at all.

Another key issue is that Medicare Advantage plans often restrict members to a specific network of providers. With original Medicare, you can generally visit any doctor or hospital that accepts Medicare, but Medicare Advantage plans are often limited to certain doctors and facilities. If you need care outside the network, it may not be covered, or it may come with higher costs, according to a Consumer Reports article. This restriction can impact your access to care, particularly if you need specialists or specific facilities that are out of network. Yet, many ads and representatives emphasize the “extra benefits” of Medicare Advantage plans without fully explaining these limitations.

Financial incentives for agents also play a role in Medicare Advantage marketing. Insurance agents often earn higher commissions for enrolling clients in Medicare Advantage plans than in original Medicare with a medigap policy, according to an article from Fortune. This can create an incentive for some agents to steer individuals toward Medicare Advantage, even if it’s not the best fit for the client’s needs. While many agents act ethically, some may not provide a balanced comparison of all options. Beneficiaries should be aware of this and seek advice from a trusted source, such as a licensed Medicare counselor or the official Medicare Plan Finder tool, to make an unbiased decision.

It’s also critical to evaluate the real costs of a Medicare Advantage plan. While many advertise low or even zero premiums, these plans often come with co-pays, co-insurance and deductibles that can add up quickly, especially during hospital stays or if you need frequent specialist care.

Lastly, Medicare Advantage plans are region-specific and may change their coverage, network or costs from year to year. A plan that works well in one area might not suit someone in another, and a plan that served you well one year could change the next. Understanding the details of coverage and comparing your options carefully each year is essential.

While Medicare Advantage may be an excellent choice for some, the decision should be made cautiously. Misinformation, financial incentives for agents and the potential difficulty of switching back to original Medicare with medigap coverage later on mean that careful research is necessary. Look beyond advertisements and verify information with unbiased sources. This ensures you make the most informed choice for your health, budget and peace of mind.

John Ray is the CEO of Haven Home Health and Hospice. He can be reached at john@havenhome.us.