A Case Study in Favor of Traditional Medicare
“Should I choose traditional Medicare with a supplement plan or a Medicare Advantage plan?”
This is a question Center for Medicare Advocacy (Center) attorneys and advocates hear increasingly often. Medicare Advantage (MA) plans make it so tempting for beneficiaries to choose MA plans to get “extras” like a dental cleaning, some post-hospital meals, or a visa card for over-the-counter medicines. But just as often we hear about cases that confirm why many people prefer the health care and financial security of traditional Medicare with a supplement (Medigap) plan over most MA plans. This is one such case.
Mr. B has traditional Medicare and a Medicare supplement (Medigap) plan. Following an accident, Mr. B was in the hospital for over 100 days. After discharge, he went to a long-term care hospital to continue his recovery for a month before he was released to go home. After a few weeks at home, Mr. B experienced some complications and he was readmitted to the hospital ICU. Last week, the hospital told his family that Mr. B had exhausted all his Medicare inpatient hospital coverage – 90 days, plus 60 lifetime reserve days. (His 90-day hospital coverage was not able to renew because he had been home for less than 60 days since his initial hospitalization – he was in the same Benefit Period).
The hospital told Mr. B’s family that he must now pay out-of-pocket for his continuing hospitalization. Hearing this, Mr. B and his family believed his necessary continued hospital care would eventually decimate his family’s finances until he could finally qualify for Medicaid. They called the Center to confirm the hospital’s understanding that Medicare’s hospital coverage was exhausted. We informed Mr. B’s family that his traditional Medicare supplement (Medigap) plan (in fact, all standard Medigap plans) provide the full cost of hospital coverage for up to an additional 365 hospital days beyond Medicare Part A hospital coverage.
Most people, like Mr. B, do not anticipate catastrophic accidents, cancer, chronic diseases, or similar life challenges. But if they need longer-term hospital coverage, traditional Medicare with a supplement plan can give families more peace of mind by having that extra security. This is the reason most people want health insurance, not for the dental cleaning, the meals, or the over-the counter medicine, but to know they have strong health coverage if life shakes the health and well-being of the individual, and their family, to the core.
 A “Medicare Benefit Period” begins on the first day a beneficiary is admitted to a hospital or skilled nursing facility (SNF) and ends when a beneficiary has not been in a hospital or SNF for at least 60 days in a row OR if a beneficiary remains in a SNF, when there has been no skilled care for at least 60 days in a row.