Case Study: Life Care Planning

Published: June 16, 2021

When Terry reached out to Scott Bloom Law, his wife of 40 years, Marilyn, had recently suffered a stroke that left her physically and mentally incapacitated. Though Terry and Marilyn had discussed various scenarios that could arise as they grew older and their health worsened, they never established a concrete plan for steps to be taken when one or both of them were incapacitated. Terry’s main priorities were to determine where she could live that would medically and financially make the most sense and how to avoid spending all of their savings where they would have nothing left to leave for their children.

Terry understood that once released from the hospital, Marilyn wouldn’t be going home again and life, as they had known it, was going to be very different. Terry knew his wife would have to enter a rehab facility but had no idea what would happen next, leaving him worried and confused. After having an initial meeting with Terry, we provided clear and personalized guidance on what his options were and how to effectively implement them. Simply discussing the home care vs. facility placement options left him feeling overwhelmed. With Marilyn not yet eligible for Medicaid, Terry understood that his best option was to pay privately for her care until she qualified.

Terry retained our firm’s services and we developed a plan where he would pay out-of-pocket for a long-term care facility for Marilyn. In the meantime, we developed a thorough and strategic Medicaid plan for when Marilyn qualified. Our plan protected Terry from expending all of the couple’s assets on long-term care and ensured that they would have something to pass along to their children. While having a plan in place before a crisis arises is always our recommendation, we were able to help Terry find a reasonable solution and develop a plan for moving forward.

At Scott Bloom Law, we have the experience and breadth of knowledge necessary to understand and advise on all aspects of eldercare issues. With compassion, honesty, and attention to detail, the team at Scott Bloom Law will be there every step of the way for you and your family, providing a plan and offering guidance through the elder law legal process. Contact us today for a free consultation.

CLIENT Testimonial

Our family had the good fortune to find Scott Bloom. He was invaluable helping us set up our trust. We had an unexpected health crises and realized that we had nothing in place to protect our children. Scott explained our options and got the necessary paperwork ready for us to hand to our family, accountant and banks. Scott was absolutely the right attorney at the right time for us. We would highly recommend him and his team.

- Tricia B., Hamilton, New Jersey

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It can be quite confusing to determine which Medicare plan is best for you. There are several types of plans, and each has its own advantages and disadvantages. Understanding some basic features will help you decide how to maximize your healthcare dollars and choices. You should review your choice periodically, especially as elements of the Inflation Reduction Act of 2022 change prescription medication and vaccine policies. Coverage can also change from year to year..

There are three basic types of plans:

Original Medicare
Medicare Advantage
Medigap

Original Medicare

Medicare is a government health insurance plan for people 65 and older. Original Medicare, sometimes called traditional Medicare, comes in several parts. Each part covers different things and has various associated costs.

Most people do not pay for Part A as it was deducted from their taxes paid while working. It is primarily for hospital visits and nursing care. However, there are many fees associated with being in a hospital that Medicare does not cover, which you still might have to pay out of pocket.

Part B requires monthly premiums, which can be deducted from your social security. You can elect to enroll in part B through Original Medicare. It covers a portion of doctors' visits, durable medical goods, and more.

Part D covers the cost of many prescription medications. You can add it to Original Medicare or purchase it as part of a Medicare Advantage plan.

Medicare Advantage

Medicare Advantage is offered through private insurance companies that Medicare approves. Most plans include Parts A, B, and D of Original Medicare with some variations from the original. There are a wide variety of Medicare Advantage plans, including Preferred Provider Organizations (PPO) or Health Maintenance Organizations (HMO). PPOs tend to have higher premiums and offer more choices than HMOs. Medicare Advantage HMOs and PPOs often have higher premiums than traditional Medicare because they usually cover more expenses, including prescription drug costs, vision, hearing, and dental.

However, the overall costs, premiums, plus out-of-pocket expenses for Advantage plans can be lower than Original Medicare because the private insurers manage patient care and limit choices. They assemble networks of hospitals and physicians to control their costs and reduce their customer's premiums. They also restrict access to certain providers and increase the cost of care obtained out-of-network.

Traditional Medicare allows people to seek care from any provider participating in Medicare, which includes virtually all hospitals and physicians.

Medigap

Medigap is a co-insurance or supplement to Original Medicare. You can enroll when you first enroll in Part B. It is also available through Medicaid, a union, or a former employer when you qualify for both programs. You can’t have both Medicare Advantage and Medigap plans. Medigap helps cover expenses that Original Medicare does not cover, such as co-pays and deductibles. Due to the enrollment restrictions, you should strongly consider Medigap when you first become eligible.

The Right Choice for You

With all the different plans, parts, choices, and restrictions, it is crucial to consider your priorities for care. Limited access to doctors and hospitals may become important if you need specialized medical care, such as cancer treatment. Before enrolling, consider what specialty hospitals are included in Advantage plans. Likewise, Advantage plans can make it difficult to see a specialist for ongoing and chronic conditions due to limitations in long-term care services. An estate planning lawyer or elder law attorney can help address long-term care planning and the potential to qualify for Medicaid when necessary.

The Kaiser Family Foundation has put together a cost analysis to help you determine when Medicare Advantage would save you money. As you can see, the longer you stay in the hospital, the less advantageous an Advantage plan becomes.

Consumer Reports notes that the JAMA reported that seniors on Advantage plans often get more preventive care than those on traditional Medicare plans. JAMA published a comprehensive paper about how Medicare plan choice affects spending and discovered that Medicare Advantage enrollees usually spend less.

A Guide in Choices after 65

Enrolling in the right Medicare coverage is one of many decisions that will affect your quality of life in your senior years. We are here to help you navigate a wide variety of choices.

If you have questions or would like to discuss your legal matters, please do not hesitate to contact our office at 215-364-1111 to schedule a consultation.

- Medigap, Medicare Advantage, and Traditional Medicare

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NEED Legal Help?

Schedule An Appointment

Call Today: 215-364-1111
Toll Free: 855-992-6337