Real Life of an MSW

In a recent letter from “Angry DIL”, the letter writer was complaining about the cost of keeping her 90-year-old mother-in-law in a senior facility. She wrote ” During this time, I found that the normally excellent Medicare she has yearly been advised to sign up for has changed. Some slick salesperson sold her another plan, and she was cut off from rehab care.”

This illustrates a common confusion between Medicare and Medicare Advantage plans. Medicare is a government program, and covers what it covers, for all participants, at any doctor or hospital or provider anywhere in the U.S. that accepts Medicare. There is only one Medicare.

Medicare Advantage is a program that takes the money that would have been spent on you by Medicare and gives it to a private insurance company that essentially gives you private insurance coverage, often HMO or PPO. These plans have different benefits and rates, and, like non-Medicare insurance plans, can require prior authorization or just flat-out deny you coverage. Medicare cannot.

The bottom line is that people need to be clear when they are on Medicare, a government run single-payer system, and when they have signed up for a Medicare Advantage plan, which is run by insurance companies.

– Plan Clarity

Dear Plan: This is a helpful distinction. One additional thought on this letter: the letter writer may want to speak to an elder law attorney or advocate about options available to her mother-in-law. As the original letter noted, the daughter-in-law and son are paying quite a lot of money for the mother’s care because the mother doesn’t have the funds. But there are other options available for getting her the care she needs with consideration for her financial position.