As you all know by now, I have been enrolled in traditional, fee-for-service Medicare for nearly four years, while all my friends but one have enrolled in Medicare Advantage (MA) plans. Why? Because that is all they see advertised. Some did not even know there was an alternative.
Skilled nursing operators have known for a decade or more that MA plans are stingy when it comes to payments, now up to $100 lower per patient day compared to traditional Medicare. It is now coming out that MA plans are not just stingy on what they pay providers, they are also stiffing their members as to what they will pay for, and how often. And this is affecting patient care in the post-acute setting, according to a new study by researchers at Vanderbilt University. This is just one of the ways they make money, but we have all known that for years with traditional health insurance.
We have been a mild proponent of MA plans getting involved in seniors housing, but only if it results in better care and outcomes for those residents. If it doesn’t, then I say stay away. It is still too early to tell what is really happening, and I always thought it could be cheaper for an MA plan to pay the monthly cost in an assisted living community, or maybe even independent living, if it resulted in a healthier resident with a better diet, fewer falls and hospitalizations, fewer doctor visits, and better mental well being because of socialization. But buyer beware. At some point the MA plan would start to negotiate the monthly rate downward, just like in SNFs.
Speaking of SNFs, the number has been decreasing for the past six years, to the tune of more than 600, according to a study by the Wall Street Journal. Most of these were most likely old and in bad condition, so the decrease itself is not alarming. What is alarming is that people still think you can provide skilled care at home at the same all-in cost. It is just not that simple, or easy. Occupancy at skilled nursing facilities is still low nationwide, so the decrease in number will not impact access for a while. But if MA plans won’t pay for it, that is another matter.
