PLANNING AHEAD: What Medicare Advantage commercials do not say

About this time most years I pull out my most recent information on Medicare Advantage plans, dust it off, and address that information in one of my columns. The reason is simple. During this time, between Oct. 15 and Dec. 7, Medicare recipients, primarily Medicare Advantage recipients, are given the opportunity to choose among several plans for the coming year. It is also a time to choose among Medicare D, prescription drug plans.

Honestly, I dread the experience of writing since, shortly after, I receive one or more phone calls or emails explaining that the individual calling or emailing is thrilled with his or her Medicare Advantage plan with reasons and is disappointed I do not enthusiastically express myself as being on board. The enthusiasm might result from a zero premium plan or vision or dental benefits or the claim that Medicare Advantage gives you “more” as named in the commercials. Usually it does not discuss care.

The Medicare system is too complicated to explain in a single column or multiple columns. However, here are some observations that might not be explained in the many television commercials at this time of year. Note that I am not necessarily addressing Medicare Advantage plans provided as retiree plans by employers although they are similar and do note there are many types of plans out there.

• If you sign for a Medicare Advantage plan when you are already on a Medicare Supplement you may not be able to return to a Medicare Supplement later. Generally speaking there is a window of time around your 65th birthday when you can choose initially to sign for a Medicare Supplement. A Medicare Supplement does what the name implies — it supplements the basic Medicare benefits that almost everyone age 65 or older is entitled to. The way it works is it states it covers “All” or “All but <a given amount>” for different services. Often I hear seniors state that, although the Medicare Supplement premium is higher, they left the hospital with nothing to be paid. That is because the Medicare Supplement, as the name implies, can pay all or most of what basic Medicare does not for hospital and similar care. On the other hand Medicare Advantage plans are all over the board as to what the plan pays. Transitioning back to a Medicare Supplement plan once you are in Medicare Advantage requires medical underwriting. People generally want to return to a Medicare Supplement when they are more seriously ill. In 25 years of practice I have never seen a client by reason of medical underwriting, able to transition back to a Medicare Supplement from a Medicare Advantage. Differences in cost of care can be substantial.

• Some commercials state that Medicare Advantage plans provide more than Medicare Supplements because they can offer prescription drug coverage. This statement is deceptive.  It appears to imply that someone who has coverage under a Medicare Supplement would not have prescription drug coverage. Here some history would be helpful. When the federal law passed regarding Medicare “D” it provided that Medicare Supplements would be unable to provide prescription drug coverage under their plan. This does not consider that many Supplement plans provided by a given company may be essentially informally “paired” with certain prescription drug plans so recipients are not without coverage although they are separate from the Medicare Supplement.

• Television commercials for Medicare Advantage raise enticements of zero premiums, extra benefits such as eyeglass coverage, physical fitness memberships, and so on. The actual benefit is often not so generous as described and does not apply to every plan. Benefits can vary widely. To the extent that television commercials might imply that all of the benefits described are available with all of the plans this is not so and the benefits provided are not consistent. A plan could indicate it includes dental services but cover only preventive work. It might indicate vision but only pay a limited credit.

Some solicitations state you may receive funds “added” to your Social Security check. This is a deduction from Part B premium available only in some locations.

Zero premiums does not mean zero cost. You can still and probably will have co-pays, deductibles and other expenses.

If you are already in a Medicare Advantage plan you will likely be deciding during this time whether to stay or to move to another Medicare Advantage plan. Try to choose wisely.

Janet Colliton Esq. is a Certified Elder Law Attorney from the National Elder Law Foundation and limits her practice, Colliton Elder Law Assocs PC, to elder law, special needs, guardianships, estate planning and estate administration with offices at 790 East Market St., Ste. 250, West Chester, 610-436-6674, colliton@collitonlaw.com. She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones CSA, co-founder of Life Transition Services LLC, a service for families with long term care needs.