Beware the Medicare Coverage Helpline

By BERRY CRAIG

AFT Local 1360

'We’ve all seen the TV ads where former pro football star Joe Namath promotes the Medicare Coverage Helpline.

“Are you getting all the benefits you deserve?”  smiles the 77-year-old Hall of Fame quarterback. He goes on to list purported new benefits from the Center for Medicare and Medicaid Services. "Broadway Joe" claims that by calling the "Helpline," fellow seniors may be able to save money and enjoy extra benefits, to boot.

 “One simple call gives you free, professional assistance to help you get more benefits and save money,” promises the Super Bowl III MVP.

“It sounds like a public service announcement from Medicare, but it's not,” warns Kay Tillow of Kentuckians for Single Payer Health Care. “It’s a scam to sign up for the privatized, for-profit Medicare Advantage plans.”

Tillow, from Louisville, and her statewide group wants the General Assembly to approve legislation that would forbid health insurance companies to deny coverage to anybody “based on [their]...age, gender, health status, claims experience, receipt of health care, or medical condition.”

In the 2020 session, Rep. Tom Burch, D-Louisville, introduced “An Act relating to Medicare Supplement insurance.” The bill didn't pass.

Burch prefiled the measure as BR 483 for the January session. You can find it at:  https://apps.legislature.ky.gov/record/21rs/prefiled/BR483.html

Tillow added that the bill is needed because when people turn 65 and become Medicare-eligible, they can opt for the traditional, federally-funded Medicare plan or choose from a variety of private Medicare Advantage plans.

“The Medicare Advantage plans are the private for-profit plans,” Tillow said. “They entice customers by offering a low or no monthly premium.  They also claim to offer a number of additional benefits.”

She said the main advantage for a senior who enrolls in a Medicare Advantage plan “is that there may be no monthly premium and the person may not have to pay the $144 monthly that is deducted from Social Security for Part B.”

Explained Tillow: “If a person who first becomes eligible for Medicare chooses traditional Medicare, purchases plan B for physician expenses, and decides to buy a Medicare supplement or Medigap plan to cover what is not covered, federal law protects the person from being charged more or denied a Medigap policy because of pre-existing conditions.”

But she warned, “If a person first chooses one of the Medicare Advantage plans and later needs to return to traditional Medicare, that protection against being charged more or denied a Medigap policy because of pre-existing conditions is no longer available.

“Those who first choose Medicare Advantage may be all right until they get really sick.  Then the limitations will become obvious.  They may not be able to find the specialists or the hospitals or the rehab facilities they need in the limited networks of the Medicare Advantage plans.  If they go out of network, the costs can be astronomical.  Once a person is very ill, the co-pays and co-insurance and deductibles and drug costs under Medicare Advantage can be horrendous.  It is then that many seek to get better coverage by returning to traditional Medicare.  But at this point, the person may not be able to purchase a Medigap policy because of pre-existing conditions.

“That is what our bill seeks to change in Kentucky.”

Four states already outlaw this form of discrimination. “We want to make this the law in Kentucky also,” Tillow said.

Click on the following for more information:

1.  In all But Four States, Seniors on Medicare Can Be Denied a Medigap Policy Due to Pre-existing Conditions, Except During specified Windows of Opportunity

2.  Medicare Advantage Enrollees discover Dirty Little Secret--Getting out is a lot harder than getting in, by Cheryl Clark, Contributing Writer, MedPage today, December 3, 2019.

(Like many of the 22 million seniors now enrolled in Medicare Advantage (MA) plans, Tom Mills belatedly discovered its dirty little secret. Also called Part C, these plans can cover a broad array of health services at low cost -- that is, until one gets sick, at which point out-of-pocket costs can soar. But once in an MA plan, getting out can be even less affordable.)