Insurers offering Medicare Advantage plans are causing nursing homes to lose money at a rapid pace, reports Amy Stulick for Skilled Nursing News. These insurers are not only paying Medicare-nursing homes less than the traditional Medicare rate, they are too often not covering enrollees’ care in nursing homes, even when they are required to do so. If our government does not step in to insist that insurers pay nursing homes the Medicare rate, there may be no skilled nursing facility care available to Medicare patients.
Today, Medicare covers care in skilled nursing facilities in limited situations. To qualify for Medicare skilled nursing care, patients must need daily skilled nursing or therapy services and receive these services in a Medicare-certified skilled nurse facility. Moreover, they must be hospitalized for at least three days in the 30 days prior to admission to a skilled nursing facility. So long as they qualify, Medicare covers up to 100 days of care per benefit period.
But, insurers offering Medicare Advantage plans don’t like to spend the money they receive to cover Medicare services. Every service they do not cover is money in their pockets. So, people in Medicare Advantage plans often do not get nursing home care or get very limited nursing home care or get poor quality nursing home care.
Marc Zimmet, the president of Zimmet Healthcare says that nursing homes are losing $274.9 million for every one percent increase in Medicare Advantage enrollment. Traditional Medicare pays about 87 percent more ($841) for nursing home care than insurers offering Medicare Advantage ($448). Not surprisingly, Medicare Advantage enrollees not only get less nursing home care than traditional Medicare enrollees, they are forced to use lower quality nursing homes.
People enrolled in Medicare Advantage need to recognize that they are taking a big risk with their health. They can’t count on getting high quality physician and hospital care; they can’t count on continuity of care; they can’t count on getting needed care. Yes, it is true that some people do perfectly well in Medicare Advantage; it’s also true that hundreds of thousands, if not millions, experience serious deterioration of their health and tens of thousands die needlessly. With Medicare Advantage, you are always playing the odds; you could end up in a killer plan.
Here’s more from Just Care:
- Medicare Advantage cannot rely exclusively on AI to deny coverage
- Don’t trust Medicare nursing home star ratings
- Medicare will identify 400 nursing homes with serious health and safety violations
- Medicare Advantage poses grave risk to rehab facilities and nursing homes
- PACE helps older adults stay in their community
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