Medicare Advantage consumers may have trouble finding unbiased help. Here’s what to look out for.
Medicare fall enrollment is an important time to review your coverage. An already daunting process can be even more complex when private insurance agents and clinics aren't transparent.
CVS Health wants you to know it’s OK if you don’t understand how Medicare works.
It’s complicated, which is why the pharmacy chain is offering free fall enrollment help from licensed insurance agents through an online help center and in select retail stores “as a courtesy for customers,” according to an advertisement published in newspapers, including The Inquirer.
Not mentioned in the ad: The insurance agency — dubbed Carefree Insurance Services — that runs the help centers is a subsidiary of CVS Health, and its brokers may have an incentive to steer people toward specific plans, such as the Medicare Advantage plans sold by Aetna, which CVS also owns.
Reviewing Medicare coverage during fall enrollment season — happening now through Dec. 7 — or signing up for the first time can be daunting, and many people welcome help from an insurance agent.
But experts caution that not all help is unbiased, which means seniors need to think carefully not only about their insurance choices, but also who they can trust to help them with the decision. Independent agents often have a financial incentive to steer people toward specific health plans, since they are paid by insurance companies, and rarely are licensed to sell all plans available in their area. And in an increasingly consolidated health-care market, relationships like the one between CVS Health, Aetna, and Carefree may not be clear to consumers.
“There’s so much at stake in this decision for beneficiaries these days,” said Juliette Cubanski, deputy director of the Medicare program at Kaiser Family Foundation, a health-care research nonprofit. “Why should Medicare beneficiaries have to do that kind of research in order to understand whether the information they’re getting on supposedly neutral ground may actually be designed to steer them to one particular plan?”
A trusted enrollment specialist can help people understand the difference between Medicare options and pick the one that’s right for them.
There are two ways for people to get Medicare when they turn 65:
Traditional Medicare, or Original Medicare, is administered by the U.S. Centers for Medicare and Medicaid Services (CMS) and is accepted virtually everywhere, but does not include coverage for vision, dental, or prescription medications. People can buy supplemental plans, called Medigap, and stand-alone Part D prescription drug plans from private insurers.
Medicare Advantage plans are required to cover the same benefits as traditional Medicare but may also offer extras, like vision, dental, and drug coverage, and typically have more limited doctor networks. These plans are sold and managed by private insurance companies.
Medicare advertising can be misleading
» READ MORE: Medicare open enrollment 2022 questions answered
Which plan is right for you depends on a lot of factors, such as whether you need coverage while traveling out of state, which medications you take, which plans your doctors accept, and how often you expect to need certain health services.
Yet the vast majority of television and print advertisements for Medicare are by companies selling Medicare Advantage plans or insurance agencies that make money selling Medicare Advantage plans. Commercials often feature celebrity endorsements and advertise benefits that may not be available everywhere.
For instance, in a recent television ad, Good Times star Jimmie Walker urged Medicare beneficiaries to call an 800 number to find out what “extra benefits,” such as dental, meals, and transportation they may be eligible for “at no additional cost.”
Though Walker doesn’t say it, the ad’s fine print notes that the helpline is not affiliated with CMS and people must enroll in a Medicare Advantage plan to get the benefits advertised — though they aren’t available everywhere.
Without citing specific ads, CMS recently issued a rare letter reminding insurers and brokers that their ads “may not mislead, confuse, or provide materially inaccurate information.”
Advertising for Medicare plans is regulated by the federal agency, but the rules are complex and leave room for interpretation. At the same time, insurers and brokers are skilled at walking what is a fine line between acceptable and misleading advertising, said Jack Hoadley, a research professor emeritus at Georgetown University’s McCourt School of Public Policy.
The CVS ad, for instance, notes in fine print that the company itself is not selling Medicare plans. Rather, the plans are sold by independent brokers.
“This is a legitimate way to sell Medicare plans, but it does come with the caveat that individual brokers may be biased by financial incentives,” Hoadley said.
In this instance, brokers hired through a CVS-owned insurance agency to offer Medicare advice at CVS pharmacies may have incentive to encourage people to sign up for plans sold by CVS-owned insurer Aetna, he said.
“Personally, I would strongly prefer that affiliation be disclosed,” Hoadley said.
A spokesperson for CVS said the agents recruited by Carefree talk to customers about Medicare options from multiple insurance carriers.
“Regardless of affiliation, all of the agents use their professional expertise to provide plan-agnostic advice to help individuals choose the Medicare plan that’s right for their particular needs,” Elise Meyer, a CVS spokesperson, said in an email.
When asked why the company did not disclose the relationship between CVS and Carefree in its ads, Meyer said: “Our goal is to provide appropriate transparency in our marketing materials, and we will review our marketing materials and make adjustments based on this feedback.”
Commissions and recommendations
Even insurance brokers not employed by or exclusively contracted with a specific insurance company may steer clients to particular plans.
A study by the Commonwealth Fund found that online insurance agent tools, which allow people to compare plans through an agency’s website, typically show users fewer than half the available plans, and in many cases, the options presented weren’t the highest-rated plans. Meanwhile using CMS’s online plan finder tool people can compare every option available in their ZIP code.
There are legitimate reasons brokers don’t sell all plans: Agents must be licensed and trained for each insurer’s plans they will sell. With dozens of plans available in some areas, offering them all — and being knowledgeable about them all — is not feasible, said Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund.
“It’s really difficult to know about all the provider networks, all the drug coverage for all the 30 or more options that are available in your area,” she said.
At the same time, consumers often don’t know what portion of available plans a particular broker is selling, Jacobson said.
CMS limits how much insurers can pay brokers per plan, which is intended to reduce incentives to steer customers, so long as a broker sells plans from multiple insurers, said James Long, a broker/manager with Young’s Insurance Services, an independent firm in Collegeville.
“Most carriers pay the max or near max — the difference between one company or another is negligible and not enough to steer a recommendation. I can’t even tell you what the differences are,” Long said.
But the fee structure inherently incentivizes brokers to sell Medicare Advantage plans over supplements for traditional Medicare. In 2020, the commission for a Medicare Advantage plan was $510, while the combined commission for Part D and Medigap plans was $400, according to an analysis by the Commonwealth Fund.
“Brokers are being paid more to put people in Medicare Advantage than to put people into stand-alone Medicare with Medigap and Part D,” Jacobson said. “There’s a financial incentive for brokers to move people from traditional Medicare to Medicare Advantage, and that’s important for people to know.”
How to get help enrolling in Medicare
When searching for the right insurance agent, ask which insurers they work with and what types of plans they sell, Long suggested. Agents who work with many insurers and who sell Medicare Advantage, Medigap, and Part D plans will have more options to offer. Agents are required to disclose the fees they receive from each insurer if asked, he said.
“People come to brokers for information, but also to pick their brains, to get their expertise, to find out some background knowledge on these options,” Long said. “That’s the human element a lot of consumers come to us for that they can’t get online or from a call center that’s handling all 50 states.”
The national Medicare helpline run by CMS, 800-MEDICARE (800-633-4227), can also help answer questions or direct you to a local State Health Insurance Assistance Program (frequently called SHIP) with offices in every county that offer free enrollment support.
During fall enrollment season, the state-run programs bring on extra workers and volunteers to staff enrollment events and individual consultations, both of which are free, said Susan Neff, director of Pennsylvania’s Medicare Education and Decision Insight program.
One major difference from private insurance agents is that SHIP enrollment specialists will not recommend specific plans and do not make money when someone signs up. Rather, they talk to people about what they need out of a Medicare plan, go over how those needs line up with all the available options, and can help complete the sign-up process once people have made a decision, she said.
The program’s counselors can also help seniors determine if they are eligible for income-based financial assistance from Medicare to offset the cost of their plan or prescription medications.
“We’re not profiting from you in any way,” Neff said. “The ads on TV, the help clinics supported by retailers — they’re in it to make money. … It’s certainly a resource, but keep in mind it’s not the complete picture and it may not be the best decision for your situation.”
Need Medicare help?
Pennsylvania MEDI: Call 1-800-783-7067 or visit www.aging.pa.gov/aging-services/medicare-counseling
New Jersey SHIP: Call 1-800-792-8820 or visit www.state.nj.us/humanservices/doas/services/ship