Should we keep this Medicare Advantage plan in force?


Q. I am a legal power of attorney and legal health care advocate for someone in assisted living. She has a long-term care insurance policy, which is paying monthly claims at this time. Since she went into assisted living last year, I have maintained her Medicare Advantage medical plan. Because the plan doesn’t cover assisted living services, are there any benefits to maintaining it? Or is Medicare enough?
— A friend

A. Thanks for your question and for stepping in to help this person.

Let’s go over what these plans may cover.

Traditional Medicare Part A covers inpatient care in a hospital or a skilled nursing home, hospice care and certain home health care benefits, said Shirley Whitenack, an estate planning attorney with Schenck, Price, Smith & King in Florham Park.

Part B pays for outpatient expenses such as doctor visits, x-ray, laboratory tests, and durable medical equipment such as wheelchairs and home oxygen supplies, she said.

A person has to be at least 65 years old and have worked at least 10 years in the U.S., or be married to someone who worked at least 10 years in this country to get Part A, which is free, Whitenack said. Medicare Part B premiums are set each year by the federal government.

Beneficiaries of traditional Medicare, however, must pay deductibles and co-pays and there is no limit to how much the Medicare recipient must pay out of pocket, she said.

That’s why many people who have traditional Medicare purchase a supplemental policy also known as a Medigap plan.

Medicare Advantage is also known as Part C, Whitenack said.

“Unlike traditional Medicare, which is administered by the federal government, Medicare Advantage plans are sold and administered by private insurance companies,” she said. “While all Medicare Advantage plans must offer the same benefits as Part A and Part B, they may offer other coverage like dental and vision care and Part D coverage for prescription drugs.”

Unlike traditional Medicare, Medicare Advantage plans have a maximum out-of-pocket limit, Whitenack said.

“The reader should review the needs of the person in the assisted living facility to determine whether it’s cheaper to pay the premiums for the Medicare Advantage plan she currently has, switch to a different Medicare Advantage Plan, or switch to traditional Medicare with or without a Medigap plan.” she said.

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This story was originally published on Nov. 24, 2020. presents certain general financial planning principles and advice, but should never be viewed as a substitute for obtaining advice from a personal professional advisor who understands your unique individual circumstances.