What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?

Question

Gretchen Morris · Accepted Answer

Benefits that are advertised nationally that only a super small percentage of the population (usually poverty level) qualify for. It's misleading for our senior population and creates confusion when there doesn't need to be any.

Answered by Gretchen Morris on March 4, 2025

Broker Licensed in MN, AZ, FL & WI

Answered by Gretchen Morris Medicare Insurance Agent

Larry Dalton · Answer

The extra add-ons to the Medicare advantage plans, such as dental, hearing, and vision coverage, are one area to be sure to evaluate each and every year, as these plans change annually and must be renewed annually. Another area is those who receive cash cards to help cover OTC utilities, etc., which are subject to change from year to year and are being carefully analyzed in Congress today as to whether to continue allowing such benefits.

Answered by Larry Dalton on April 3, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Tony Capraro III · Answer

The ZERO premium monthly hype! Why do you think those commercials are shown 24/7? The insurance companies are making huge $$$ with them. There are always an OUT OF POCKET maximum the client is responsible for! Most Plans are Max Out of Pocket from $4500-$10,000 and that's ANNUALLY! Disclosure-I offer Medicare Advantage Plans through Humana -and they are great plans for folks who know both the Pros and Cons of these plans! Work with someone who offers BOTH Medicare Advantage and Medicare Supplement/Medigap like I do!

Answered by Tony Capraro III on March 27, 2025

Agent Licensed in NH & ME

Answered by Tony Capraro III Medicare Insurance Agent

Gary Church · Answer

Dental and vision are basic dental and vision plans. Dental is generally an HMO with a maximum annual coverage of $1500.00. You are limited to a small network.

Mark Maliwauki · Answer

I wouldn't necessarily say they are over hyped but many people never even use the OTC or Over the Counter dollars each quarter. It is a nice benefit but depending on the plan you have, the items could be more expensive than they would be if you were able to just pick them up at the pharmacy or grocery store. 

Outside of that, there are benefits for vision, hearing and dental that are included in the plan coverage which if they weren't, you would have to have a separate policy for or pay out of pocket anyway. Some coverage is better than no coverage.

Cynthia Nakaya · Answer

By far the most overhyped benefit of Medicare Advantage plans is food cards. Advertisers tout food cards with generous benefits and seniors think they're losing out if they don't have one. However, plans vary greatly by county and state. Sometimes, food cards are dependent on your income and existing chronic conditions. 

Any time you hear about generous food cards, by all means, contact an agent to see if they are available in your area, but don't believe the hype that you will get hundreds of dollars a month for food. Those benefits are few and far between.

Antonio Espino · Answer

The giveback plans. They give money back, but at what cost? The health plan will have higher copays for everything. It's only good for people that rarely go to the doctors and would like to save money on their premiums in the early stages of them being on Medicare.

Answered by Antonio Espino on April 22, 2025

Broker Licensed in TX

Answered by Antonio Espino Medicare Insurance Agent

Steven Bleicher · Answer

I once had a client who was so enamored of a free gym membership that once I pointed out to him that his health issues should be of a greater concern that he immediately backed off, saying that I was absolutely right! Furthermore, just because an Advantage plan, subsidized by the federal government, contains no monthly premium, the “give & take” here is that each MA plan has a fairly steep deductible, averaging about $3,000.00. So when you are “officially” admitted to a hospital, it is likely that this high amount will come out of your own pocket! Then, it starts all over again in the next year.

Answered by Steven Bleicher on June 3, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Michael Crocker · Answer

The most "overhyped" benefits of Medicare Advantage plans are those "benefits" that don't exist at all, at least not for most people. One common example is a "grocery card." It's an old bait and switch ploy that has been used by disreputable telemarketers for years: Call an unsuspecting senior and ask him/her if they would like more information on getting on a plan that gives them hundreds of dollars for groceries each month. The problem is these benefits are usually available only to Medicare recipients who have a low enough income to qualify for full Medicaid benefits. That rules out the vast majority of seniors, but the telemarketer now has the senior on the phone and can apply pressure to move them to a new plan anyway, without doing a proper needs analysis.

Answered by Michael Crocker on April 5, 2025

Broker Licensed in SC

Answered by Michael Crocker Medicare Insurance Agent

Valentina Gatewood · Answer

In my opinion it is the giveback plans. They offer money back towards their part B premium however a lot of times, it is not a good fit an puts the client in a bad position.

Fred Manas · Answer

Seniors should be cautious about overhyped benefits in Medicare Advantage plans, particularly regarding "free" benefits like dental or vision coverage, as these often come with limitations or caps. They should also be wary of claims of lower premiums or no out-of-pocket costs, as copays & coinsurance can still apply. Here's a more detailed breakdown of what to watch out for:
1. "Free" or Limited Benefits:
Dental and Vision:  Brochures & ads may tout "free" dental or vision coverage, but average coverage limits for vision are often minimal (e.g., $160), and dental coverage may have annual dollar limits (e.g., $1,000 or less).
Fitness:
Fitness benefits might have restrictions on usage times or gym access.
2. Copays and Out-of-Pocket Costs:
Despite $0 premiums:
Many plans have zero premiums, but beneficiaries still have to pay copays and coinsurance for services. 
Annual maximums don't cover everything:
The annual maximum out-of-pocket costs for medical care often exclude prescription drug costs. 
3. Network Restrictions and Prior Authorization:
Provider Networks:
Some plans restrict coverage to in-network providers, limiting choices for specialists or preferred doctors. 
Prior Authorization:
Many plans require prior authorization for certain services, which can delay or even deny care. 
4. High Premiums and Unexpected Costs:
Monthly Premiums:
While some plans may have low or zero premiums, beneficiaries still need to factor in the Medicare Part B premium, which is $185 in 2025, according to the National Council on Aging (NCOA). 
Unexpected Costs:
Some beneficiaries may face unexpectedly high costs when they become ill or discover that their network lacks the necessary providers. 
In short, seniors should carefully evaluate Medicare Advantage plans beyond the surface-level benefits and consider the potential drawbacks like network restrictions, prior authorization, and hidden costs.

Steve Brauer · Answer

The most overhyped benefit is the "money back" plans that many Medicare Advantage Plans offer. Don't get me wrong, they are a good product IF you are aware of the other benefits that are not nearly as robust as the non "money back" plans. There are some insurance products to pair with "money back on your Part B plans" that most brokers are not aware of.

Answered by Steve Brauer on April 15, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Gary Henderson · Answer

Well that's a long list 
First of all, they're not as good coverage as Medicare supplement plans not even close 
People love them because they have $0 monthly premiums but once they become seriously ill they can spend anywhere from $4 to $10,000 a year out of pocket 
They offer freebies. Beware of freebies, the more they give you the higher your maximum out of pocket is each year 
The dental plans are terrible. They have so many restrictions that they are almost of no value except to get your teeth cleaned and it's often more and more difficult to find a dentist that will take them 
The vision plan coverages okay 
Hearing plan coverage is okay 
If they start offering you like $50 a quarter towards pharmacy and items like bandages, cough syrup etc. Beware that's a trap. The more they give you the higher your max out of pocket. What you want is the least of perks and the lowest Max out of pocket because once you get sick that max out of pocket is the maximum you have to spend before your insurance kicks in at 100% too. So if it's 5'8 $10,000 a year and you have a long-term illness, you're going to be paying that every year and and you'll go broke. That is one of the leading causes of bankruptcy today and their poor coverage 
Medicare supplements you don't have that issue

Andrew Kramer · Answer

I always tell my clients to focus on the core benefits of the Advantage plan, in this order:
1. Are all your "must-have" Dr's on the plan?
2. What are the co-pays and max out-of-pocket
3. Does the plan have a monthly premium, if so how much?
The ancillary benefits of dental, vision, OTC allowance, etc., are of least importance, unless #'s 1, 2 and 3 are equal, then the other benefits can be compared.

Barbara Barnes, CMIP® · Answer

Most commercials that I see on TV speak almost exclusively about the ‘extra’ benefits of Medicare Advantage, like dental, vision, grocery cards, OTC drugs and gym memberships. They do not talk about the MEDICAL benefits, which are the basis and purpose of Medicare. The ’extra’ benefits are not guaranteed from year to year and often do not make-up for the increased medical costs and risks of a Medicare Advantage plan.

Answered by Barbara Barnes, CMIP® on June 2, 2025

Agent Licensed in PA

Answered by Barbara Barnes, CMIP® Medicare Insurance Agent

Ellen Diehl · Answer

I have one person who called me who is 77 years old and she was conned into an Advantage plan that did not have Emory hospital in it.  Now she has no access to Emory hospital.

Robert Rowe · Answer

I think Over The Counter card benefits are the most overhyped benefit on a MAPD. The amounts are typically pretty insignificant in comparison to what you can SAVE on drug costs with the right drug plan or what you can SAVE in doctor visit costs by making sure your doctor and specialists are in network.

Answered by Robert Rowe on May 12, 2025

Broker Licensed in MI

Answered by Robert Rowe Medicare Insurance Agent

What are the most overhyped benefits of Medicare Advantage plans that seniors should be wary of?

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