When this topic comes up, many people generally think negatively about financial support for an ex-spouse. But that's not the one we're discussing today. No, this is more of a love story.
Mack had called our office asking questions about the Medicare plan they had chosen, and our Client Care team immediately scheduled time to meet with his Certified Medicare Planner™. Mack began by explaining that his spouse of 45 years was experiencing a long list of medical issues, and he just needed to get some hard facts about how to best care for her and the fact that they were more than concerned about the cost of care she may need.
Getting the Coverage Facts
He then began with a list of medical equipment and wanted to ensure their plan covered what they needed. Then, Mack asked about skilled nursing, hospital visits, long-term care, and hospice. We reminded him that since they had chosen a Medicare Advantage plan, they had to use doctors, hospitals, and other service providers in their network. The good news was that they had chosen a great plan covering almost every hospital where they lived.
As far as cost, they would have co-pays until they reached their max out-of-pocket (MOOP) for the year. Again, this is good news as their plan has a low MOOP of only $3,000 for the year, and once their co-pays hit that amount, there will be no more medical co-pays for the year. Hospitals, skilled nursing, and hospice were all covered in their plan, but long-term care was not covered by any plan. "That's not going to be an issue, as I'm going to take care of her myself," Mack replied. They also have two daughters nearby to lend a hand.
Glenda was also on the call and started making fun of Mack by remarking, "Thank God for our daughters! Mack's a terrible cook! At least I won't starve to death!" After we all laughed, Glenda quickly added that she was only kidding, and that Mack took excellent care of her. As we finished the call, I could only reflect on how wonderful it was to talk to a couple still so in love after 45 years.
Not sure how your plan coverage works? Give us a call and we can help you understand what you have.
By David Edge
David Edge is a retirement lifestyle writer and contributor to the ARA monthly newsletter. His articles blend personal stories with practical insights on living well in retirement.
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Easy Eddie's Take
David's story about Mack and Glenda really hits home for me. A lot of people ask me, "How do I know if my Medicare Advantage plan will cover everything my spouse needs?" The key is understanding your plan's provider network and that annual out-of-pocket maximum. For 2026, Medicare Advantage plans can have a maximum out-of-pocket limit of up to $8,850 for in-network services, so Mack and Glenda's $3,000 limit is excellent.
Here's what many couples don't realize: Medicare Advantage plans through the Centers for Medicare & Medicaid Services cover skilled nursing facility care for up to 100 days per benefit period, but you're right that long-term custodial care isn't covered by Original Medicare or Medicare Advantage plans. That's where family caregiving, like Mack is planning, or long-term care insurance comes into play.
If you're caring for a spouse with multiple health conditions, take time during Medicare Open Enrollment (October 15 to December 7 each year) to review your plan's provider network and prescription drug formulary. A little preparation today can make all the difference when you need care tomorrow.