MoneyMindedMoms: Will Medicare Advantage Pay for Long-Term Care?

The newer Medicare Advantage plans cover all the services of the traditional Medicare program with smaller co-pays and deductibles so that a Medicare supplement isn’t needed. Most people pay a premium for their Medicare Advantage (MA) plan but it can be significantly less than a Medicare supplement premium. Some MA plans pay for extra benefits not covered by Medicare such as benefits related to vision and hearing care, and you can buy them with or without prescription drug coverage (Part D of Medicare). The trade-off is you are willing to use the health care providers in their network for all non-emergency services. You can learn more about the options available to you at www.medicare.gov.

Now, because Medicare Advantage plans aren’t subject to the rules of original Medicare, they don’t have to pay anything for care at home or in a skilled nursing facility.

My father-in-law had serious heart surgery after my mother-in-law died, and even though his doctor said it was essential for him to recover in a skilled nursing facility, his Medicare Advantage plan insisted he could go home. He was re-admitted to the hospital through the ER one week later. After a short hospital stay, he was sent home again against his doctor’s wishes. Why? Because Medicare pays a flat amount to the Medicare Advantage plan for each participant. It is up to the Medicare Advantage plan to manage the care of each participant in order to make enough profit to stay in business.

If you are trying to help someone close to you with these issues and need a sounding board, please leave a comment or email me at ltcshelton@gmail.com. If you need information quickly about all aspects of long-term care, please email me your mailing address and I will send you my newest book,The ABC’s of Long-Term Care Insurance plus the cost of care and Medicaid long-term care payment guidelines for your state.

Phyllis Shelton is the President of LTC Consultants, a Nashville-based consulting company specializing in long-term care insurance consumer education and training since 1991. She experienced first hand the implications of long-term caregiving with her grandfather, mother and brother. Because the need is so great, she is now focused on helping consumers who don't have a local agent acquire long-term care insurance.