Dy-no-MITE!

Jimmy ‘J.J’ Walker encourages viewers to call the Medicare Helpline, but rather than being a public service, the ad is a pitch to sign up for a privatized, for-profit Medicare Advantage plan that may or may not meet an individual’s needs, columnist Joel Mekler writes.

When it comes to sales pitches to seniors about insurance to fill the gaps in Medicare coverage, there is a lot of incomplete and deceptive information involved. And sometimes, total misinformation.

Unfortunately, Hall of Fame quarterback Joe Namath is contributing to the confusing mess.

Joe Namath is making a comeback. No, it’s not on the playing field. He’s returning to his role as pitchman and paid spokesman for the Medicare Coverage Helpline, which sells Medicare Advantage (MA) plans. With the Medicare Annual Election Period right around the corner, for-profit health plans that deliver Medicare benefits are using stars like Joe Namath and newcomer Jimmy Walker— aka Mr. “Dy-no-mite!” — to mislead people into signing up for coverage that very well might not meet their needs if they get sick or need a lot of costly care.

Perhaps even more egregious, the Centers for Medicare and Medicaid Services (CMS) is allowing Medicare Advantage plans to advertise in this manner.

Namath says “CMS has officially authorized new benefits that Medicare Advantage Plans may include. One simple call gives you free, professional assistance to help you get more benefits and save money.”

It sounds like a public service announcement from Medicare.

But it isn’t.

It’s a pitch to sign up for a privatized, for-profit Medicare Advantage plan.

It is true that a person may be able to lower monthly costs by enrolling in one of these plans.

That’s a powerful incentive in a time when the majority of seniors live on tight budgets, many just one medical emergency from financial disaster.

Namath continues: “And like you I’m at home staying safe, but I wanted to get this message out. To make these uncertain times easier and safer while at home, Medicare Advantage plans have added new benefits including telephone appointments with your doctors, in-home aides, home-delivered meals, home-delivered prescriptions, and so much more.”

Namath makes it sound like all these benefits are yours by simply making a call. “But you don’t get all the benefits automatically, you need to enroll. The easiest way to enroll is to call the Medicare Coverage Helpline. It’s now more important than ever to make sure that your Medicare coverage is up to date,” says Namath.

You’ll seldom find talk on these TV ads about making sure people are covered for the huge amounts doctors and hospitals sometimes charge and Medicare doesn’t cover. What are the trade-offs, for example, between buying an Advantage plan, which pays those charges after you satisfy a large out-of-pocket maximum ($7,550) or buying a traditional Medigap insurance supplement Plan G, which covers those charges right away? A couple with Medicare Advantage could pay as much as $15,100 a year before their plan would pay for anything!

You may be OK for a time and save money monthly — as long as you don’t get sick. Once you need to use the plan, you will discover the problems that come from being in a for-profit plan that makes more when it denies your care. Your choice of physicians will be restricted to a list. The specialist you need may not be anywhere near where you live. The hospitals and rehab centers will be limited. The post-hospitalization facility available to you may be second class. The drugs you need may now cost a fortune.

Wait, there is even worse news.

Even after you enroll in an MA plan, perhaps enticed by a few dollars in savings for a pair of glasses, you can return to traditional Medicare in the future. But in all but four states (New York, Connecticut, Massachusetts, and Maine) state laws prohibit you from buying a Medigap plan without an insurer scrutinizing your health status.

If you develop a pre-existing condition, you may be ineligible for a Medigap policy. I’ve met many people over the years who bought an Advantage plan, got sick, and needed to go out of network for treatment. They learned the hard way they were shut out of the Medigap market for good.

The so-called Medicare Coverage Helpline includes some tiny print disclaimers that you can barely read on the television screen. The fine print of the ad says “The Medicare Coverage Helpline is a private for-profit lead generation campaign and does not offer insurance and is not an insurance agency or broker. Your call is sold to a licensed insurance agent…”

Another disclaimer states that not all benefits and services are available in every geographical area. Take the Medicare buy-back benefit, for example. Some Advantage plans out there can “buy back” your Part B premiums ($148.50 in 2021), ultimately putting money back into your pocket. It’s right to be skeptical about the idea of an insurance company wanting to give you money. As you can imagine, these plans might be harder to find than more standard Advantage plans, and there may or may not be one in your area. Research has shown that less than 1 percent of all Advantage plans have this type of benefit. Actually, there are only a few counties in Florida that provide the buy-back benefit.

As you’re looking into available Medicare Advantage plans that offer the Part B buy back benefit in your area, be sure to consider what you might be giving up. Remember, all plans are different, but it is possible that a plan with a Part B buy back option will have higher copayments and deductibles – which may not matter to you if you don’t spend a lot of time in the doctor’s office. The devil is in the details. The same can be said for other benefits such as transportation to physician offices, home-delivered meals, and home health aides.

Sadly, nothing ever changes when it comes to hawking insurance to fill gaps in Medicare coverage. The fervent sales pitches, the misinformation, and the incomplete and deceptive information continue to proliferate. The 800 numbers lead to an insurance brokerage firm or agency that apparently has a network of licensed agents located around the country. Callers are asked to give their ZIP code and then are transferred to an agent who can give the “free benefits” review.

If you just can’t control yourself from calling one of these hotlines, never agree to pay directly for such assistance! Also, never provide any personal information to anonymous callers such as a credit card number or your Medicare or Social Security numbers. It is always a possibility that the caller is looking to obtain such personal information for felonious and fraudulent reasons.

The Pennsylvania Medicare Education and Decision Insight (PA MEDI) formerly known as APPRISE is comprised of health insurance counselors that help you understand your Medicare options. PA MEDI is free, confidential, and staffed by trained volunteers that provide clear and objective advice about available insurance and allow you to make informed, educated decisions.

If you prefer to work with a licensed agent, make sure it is someone you know and can trust who specializes in working with Medicare and is dedicated to working with you for the long term and not just interested in a quick sale.

Then, during each annual enrollment period, work with that agent to obtain the best plan for you, and hang up on these other fraudulent phone calls.

(Joel Mekler is a certified senior adviser. Send him your Medicare questions at mekbab2000@verizon.net.)

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