Medicare Your Coverage Options

New study finds Medicare Advantage plan enrollees end up in lower quality nursing homes than people in traditional Medicare

Written by Diane Archer

A Brown University School of Public Health study published in Health Affairs finds that Medicare Advantage plan enrollees end up in lower quality nursing homes than people in traditional Medicare. The unanswered question is why. Given the financial incentives of Medicare Advantage plans to contract with the lowest cost providers, it would make sense that their nursing home networks, much like their physician networks, more often than not include poorer quality providers than traditional Medicare.

Medicare rates nursing homes between one and five stars and while these star ratings do not necessarily reflect good quality, they are one quality measure. The Brown researchers found that people enrolled in Medicare Advantage plans are more likely to end up in nursing homes with fewer stars than people in traditional Medicare. Additional research will determine whether financial incentives lead Medicare Advantage plans  to contract with both lower cost and poorer quality nursing homes than traditional Medicare.

The researchers controlled for a number of variables and found that people enrolled in fee-for-service Medicare “have substantially higher probabilities of entering higher-quality Medicare skilled nursing facilities” than people enrolled in Medicare Advantage plans, based on the nursing homes’ star ratings and their hospital readmission rates. A Massachusetts study found that health plans with narrow provider networks tended not to include prestigious hospitals and hospitals with higher star ratings.

If you or someone you love is entering a Medicare-certified skilled nursing facility, check out your options. If possible, avoid chain nursing homes, which, according to a Kaiser investigation, deliver poorer care than independent nursing homes. Unfortunately, your options may be limited if you are enrolled in a Medicare Advantage plan. And, remember, Medicare five-star ratings are only one limited measure of quality; hospital readmission rates are another.

Here’s more from Just Care:

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9 Comments

    • Some MA plans are excellent and THEIR members go to good SNFs. Problem is lowest premium and copay MA plans tend to be rated poorly but poor and needy patients select them.

      • Vince,
        I am neither poor nor needy, and I would never voluntarily pick any for-profit Medicare Advantage Plan over Traditional Medicare. Unforunately, my former employer is able to pick my Medicare Advantage Plan. My only choice is between a PPO or HMO. My former union (SEIU), to whom I paid dues for over 25 years, sold retirees out and agreed to that! I do not know what my former employer pays for my Medicare Advantage Plan, but my guess is that it is as little as possible!

  • I don’t know why you keep picking on Medicare Advantage Plans, they work fine for many people including me! In this case the logical assumption is that most people with the advantage plans have less income, maybe less healthy so naturally they’re going to end up in less desirable conditions. Get a clue, I’ve been in several different plans with different companies for 10 years and have been very happy with them! And oh yes, saved a lot of money!

  • John,
    I pick on Medicare Advantage plans hoping to educate people like you! Medicare Advantage plans are contracted by the federal government to FOR-PROFIT insurance companies. For-profit insurance companies exist to make a profit—period. Traditional Medicare is administered by the federal government and exists to provide medical care to recipients—period. You should be able to figure out which is more likely to provide better care! Hint: In most cases, it is not a for-profit insurance company since their need to make a profit (not your care) is its priority.

    • The issue you’re ignoring is Medicare only covers 80% [with a lot of limitations] of your healthcare and the rest is up to you. So you can take your chances with that or you add on medigap coverage which most people do and guess who sells that. The same insurance companies you’re complaining about! And it costs a lot more than an Advantage Plan and offers less fringes. Obviously you’re not on Medicare or you would know all that!

      • John,
        Duh! See my post of May 17, 2018. I am, unfortunately, on Medicare Advantage, which was NOT my choice, and I am well aware that Medigap policies are sold by for-profit insurance companies. You usually get what you pay for—so just hope you don’t get really sick while you have your cheap Medicare Advantage policy!

        • You have a right to your opinion, and obviously I DON’T agree and there are plenty of others that don’t. I just don’t appreciate that you make it sound like the gospel truth. Sorry you didn’t have a choice.

  • Hogwash! Isn’t this what used to be called “glittering generalities” in high school? It all depends on the plan and SNC is only a part of the care- 20 days. I have Capital District Physicians Health Plan here in the Albany, NY area and it is excellent!

    Hogwash! It all depends on the individual plan. Here in the Albany, NY area, I have Capital District Physicians Health Plan and it excellent and I say that having been through a small intestine resection and a cerebral hemorrhage. SNC is a small 20 day thing that was handled well. I get a lot of preventive care and although copays are always climbing, the plan is excellent.

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