Beware of False Advertising Claiming No Charges for Medicare

You probably saw the onslaught of ads during Medicare’s Annual Enrollment from October 15 through December 7. Let’s look at what the ads said and what is real.

First, understand that the purpose of the ads was to get you to make a call or give your name to a marketing platform. Once you did that, you probably got phone calls from one or several sales people pushing you to sign up for whatever plans they were promoting. All the claims of free stuff and no payments for premiums or services were simply bait and switch. You thought you would get a deal, so you made the connection. That is risky and I will explain.

The ads were pushing Medicare Advantage plans. At Professor Medicare, we broker these plans in Colorado and 20 other states. Approximately 65% of our clients enroll in Medicare Advantage plans. We know how they work and what they provide for clients. We also know what you have to pay for and what premiums and services have a zero cost.

When you enrolled in Medicare, you signed up for Parts A and B. A has a zero premium if you have 40 units of work recorded with Social Security. If you have less than 40, you may have a premium; but if your spouse has the units, you could avoid the premium. Part B has a base premium of $170.10 for 2022, and this is income based. If you have a higher income, you will pay more. If you have a lower income, you may not be required to pay the Part B premium.

The ads make it seem that everyone can get the $170.10 taken care of with zero premium. Here is the reality. If you are an individual/or couple on Medicaid and have a monthly income of $841/$1261 or less and resources of $2000/$3000 or less, you will have no premium for Part B and zero copays and coinsurance for health services. You will also have minimal or zero costs for medications. But what if you have an income above $841/$1261?

Medicare Savings Programs help those individuals and couples making less than $1469/$1980 a month with resources less than $7970/$11,960. Anyone who fits that profile will have a zero pay for Part B. If the income is less than $1094/$1472 for individuals and couples with a resource level below $7970/$11,960, then the following will have zero copays/coinsurance: Part B premium, medical services. For medications, the Low-Income Subsidy program will cover medications.

In summary, your income needs to be less than $1469 for individuals and $1980 for couples in order to avoid paying the $170.10 monthly Part B premium. The ads don’t tell you that, do they?

However, there are a few Medicare Advantage plans that give rebates for $30-50 monthly, and we apply those to the Part B premium.

Most Medicare Advantage plans have a zero copay for visits to one’s Primary Care Physician. For all other services such as specialists, tests, hospitalizations, out-patient surgeries, and physical therapy, there are charges. The ads have taken that zero copay for Primary Dr. visits and made it appear that there are no charges for any service. That is misleading and edging toward fraudulent.

Approximately 42% of all Medicare enrollees have chosen Medicare Advantage plans. Here are a few of the points of attraction for those plans.

• Many have zero premium and zero deductible

•  Include dental, vision, hearing, fitness and Over the Counter goods

•  Wide networks

•  Some require referrals and some don’t

•  Reasonable copays/coinsurance

•  Yearly Max Out of Pocket- a safety net to protect your retirement savings

When we meet with clients, we compare Medicare Advantage plans to Medicare Supplement plans. Doing so allows our clients to understand what they get and what it costs. And that is much different that running ads promising the moon and then having people discover it was nothing more than Velveeta cheese. Please contact us today if you have any questions. You can also call or text us at (858) 689-7445.