Medicare is the federal insurance plan for those age 65 and older and for some younger people with disabilities. For those who want something other than standard Medicare, the Medicare Advantage plans are one option. They are partly funded by the government, but are a for-profit business run by private insurance companies.
Increasingly, Medicare Advantage plans are offering enticing extras. Some offer “flex cards” that can be loaded with cash value by the insurance company and used like a credit card. They are legal and approved by the federal government in order to encourage healthy habits that may decrease health care costs. And they are morphing: What started out in 2020 as cash for healthy groceries or money for off-the-shelf medicines is now multiplying into a new universe of Medicare Advantage plan options, presented with all the marketing dazzle the private insurance industry can muster.
“I tell you, you get bombarded so much as you are nearing 65 years old,” said Barbara Pool, 80, a former nurse who talks to her friends about finding plans. At times, salespeople have encouraged her to buy a plan because of a benefit she knows she’s not eligible for. Even now, she said, “They call all the time. They want to offer you more benefits. ... Had I not been working in Medicare, with Medicare, I would have been confused myself.”
The incentives are one more element of a complex insurance landscape for seniors to choose from.
“People are generally pretty satisfied with their Medicare Advantage plans,” said Medicare expert Meredith Freed, a senior policy analyst at the health research nonprofit KFF. “There are situations where people run into some issues” like unexpectedly not having a doctor or treatment covered, she said. “It’s just important to look at their options and find a plan that’s best for them.”
Sonder Health Plans, a relatively new company with coverage in metro Atlanta, is all in on the extra benefits and cards. Its Medicare Advantage plans will pay for things such as fishing licenses, golf lessons, social clubs or physical club memberships.
“We get pretty creative,” said Suzanna Roberts, CEO of metro Atlanta-based Sonder Health Plans. But she said quality health coverage is the heart of the company’s business, not the extras.
“Yeah, it’s very marketable,” Roberts acknowledged. But the extras like memberships or passes can be a powerful tool for mental and physical health, she said. “It encourages people, who maybe are sitting in the house and they’re like, ‘Oh, man, I haven’t been fishing in forever, they’re gonna pay for it, I may as well.’”
Roberts makes the case that Sonder simultaneously offers strong coverage, reducing out-of-pocket costs for patients with certain ailments, like diabetes.
But skeptics of flex cards and the incentives like Kirk Lyman-Barner say that’s not always the case with every company. They fear customers are distracted by the lures to ignore the crucial plan elements like making sure doctors, hospitals and needs are covered, and out-of-pocket costs are low.
The Medicare Advantage industry was cited in a 2022 report for misleading advertising, such as advertising benefits as extra that some patients already were entitled to, or hiding the fact that only certain groups of patients are eligible for the extra benefits, like people with chronic illnesses. And those are the legitimate companies. Patient advocates warn seniors to watch out for flex card scams: people pretending to be Medicare agents selling bogus cards while asking for personal data.
Big options, big stakes
“I advise my clients to think of the insurance company as a casino,” said Lyman-Barner, who sells insurance in Sumter County. (Sonder does not offer plans there.) “They know how to make money. ... And if they’re offering you this, it’s not because they’re being generous, it’s going to cost in other ways.”
Medicare expert Freed said she would really like to see good data on whether having flex cards and activity benefits results in better health outcomes. “If they are really helpful to people, that’s something we would want to know,” she said. “But we don’t have that information right now.”
Pool has a Medicare Advantage plan with a grocery card and a pharmacy over-the-counter card. “I love it,” she said.
Like most seniors, in the past 15 years, since Pool reached the age of 65, she has had options. She had to weigh how much coverage she could afford.
Seniors now face a crucial decision that they often don’t find out about until it’s too late. Some of the strongest choices are only available in the year a person turns 65, or when they first become eligible for Medicare. If someone chooses minimal coverage, then a couple years later want to choose a Medicare Advantage plan or a Medigap plan and drug coverage, they may have to pay a lifelong penalty to have that other coverage.
A coverage breakdown
The choices break down to Medicare; Medicare combined with private Medigap supplementary plans and Medicare’s drug plan; or Medicare Advantage.
- Traditional Medicare (Parts A and B)
Traditional Medicare is also known as Medicare Parts A and B. Part A pays for hospital stays after a deductible has been met and possible copay. Part B pays 80% of doctor visits, with a deductible. These plans mostly do not pay for drugs at all.
The Part A policy is free for anyone who has paid into the Medicare system long enough. Premiums for Part B depend on the senior’s income and assets, but are often about $175 per month.
- Medicare drug coverage (Part D)
Medicare part D pays for drugs, covered by private insurance companies that contract with the government. So a patient can sign up for traditional Medicare parts A and B, and then also buy a Part D plan.
If they sign up as soon as they’re eligible, the patient may get pretty affordable drug coverage. But if they wait past their initial eligibility period — a certain time past their 65th birthday or past their retirement from an insured job — they’ll pay a penalty every year.
The amount of individual drug costs covered by Part D depends on the plan. Starting in 2025 there will be a new annual $2,000 cap on some out-of-pocket costs.
- Medicare Supplement Insurance (Also called Medigap)
Medigap is slang for supplemental private plans that fill in the gaps of traditional Medicare. So seniors can buy traditional Medicare Parts A and B, then add the Part D drug coverage, then add supplemental private Medigap plans to pay the 20% of doctor and chemotherapy bills that Medicare doesn’t cover as well as other unmet costs. The supplemental plans might also cover vision and dental care. They’re not likely to cover hearing.
If they sign up for Medigap as soon as they’re eligible for Medicare, the patient may get pretty affordable coverage. But if they wait and sign up later, the insurance company will assess the patient’s health needs and they could find themselves paying much larger prices for the coverage for the rest of their lives, or they may be denied a Medigap plan altogether.
- Medicare Advantage (also called Part C)
Medicare Advantage is run by commercial health insurance companies. It lumps Medicare and some additional coverage into one policy.
Patients must carefully evaluate what they might have to pay out-of-pocket, and what services the plan offers. Ask if the plan covers hearing, vision, dental and drugs.
Importantly, the plans have limited networks of doctors they’ll cover. Check to see which doctors are in the plan’s network.
These plans also may offer “flexible benefits,” which might just be vision and dental, or might be something like a flex card for groceries or a bonus in social security payments. Crucially, these extras may only be available to certain types of patients, and it’s important for buyers to check if they qualify.
Happy with his choice
Chauncey Mayfield is happy with his Medicare Advantage plan from Sonder, and he gives talks about it, paid a fee by Sonder. He is diabetic and says the plan reduced out-of-pocket costs for his drugs that were $1,600 per month on his previous Medicare Advantage plan, and also paid for him to have a constant insulin monitoring device that transmits his blood results to a smartphone.
He’s got a grocery card from Sonder that can be used for healthy purchases, but the coverage was his reason for buying, not the card, he said. “That for me is not the deal breaker,” he said.
Where to find unbiased advice
Insurance agents are paid by commission. Other options include:
State Health Insurance Assistance Programs, or SHIP. Georgia SHIP is at 1-866-552-4464, option 4.