Nursing home surprise: Advantage plans may shorten stays to less time than Medicare covers

[kgmom219]

Had a DAUGHTER call me today, started out super bitchy, about making sure her mother wasn't going on MA 12/1. Ummm…no.

Shes an SLP in a SNF.

 

[kgmom219]

Charlene Harrington, a professor emerita at the University of California-San Francisco's School of Nursing and an expert on nursing home reimbursement and regulation, said nursing homes have an incentive to extend residents' stays. "Length of stay and occupancy are the main predictor of profitability, so they want to keep people as long as possible," she said. Many facilities still have empty beds, a lingering effect of the COVID-19 pandemic.

When to leave a nursing home "is a complicated decision because you have two groups that have reverse incentives," she said. "People are probably better off at home," she said, if they are healthy enough and have family members or other sources of support and secure housing. "The resident ought to have some say about it."




Oh, there is another side to the story. I feel worse for the people on Original Medicare who are under observation for days or spend 2 nights in the hospital and then don't qualify for SNF at all. At least if they have an MAPD they don't have to be in the hospital 3 days to even start getting SNF. Good and bad of both I guess.

Charlene issue is accurate and NOT MY PROBLEM

What IS my problem is clients getting kicked out of SNFs by MAPD.

Tell the industry to get their own house in order before bitching at us.

And the Under Observation rule is no longer an issue. Docs, hospitals and SNF know how to work the system

 

[DonP]

Let's talk about all the med sups I see the past 6 months with 10-15% rate increases . In 5 yrs 80 yr olds will be paying $550 a month for a med sup and pdp card . I expect huge movement from sup to mapd in the next 2 months .

 

[goillini52]

Let's talk about all the med sups I see the past 6 months with 10-15% rate increases . In 5 yrs 80 yr olds will be paying $550 a month for a med sup and pdp card . I expect huge movement from sup to mapd in the next 2 months .

My 1st wife's turning 65 and called me to pick my brain.....wanted to compare Med Supp to MA. I tried to be unbiased. I explained how Plan G works. When I started to explain MA, when I mentioned copays and networks, she didn't want to hear anymore about MA. She also likes that her healthcare costs will be predictable with a Med Supp and I told her the premium will go up 5-10% a year and if she can pass underwriting, she can switch every few years to get a lower premium.
.
I think there's a place for MA, but there's a lot of people that don't like copays. Some of the old people would rather pay the extra money for a Plan F (even though it's not a good buy), because they don't want to mess with any deductible/bills.

 

[DonP]

My 1st wife's turning 65 and called me to pick my brain.....wanted to compare Med Supp to MA. I tried to be unbiased. I explained how Plan G works. When I started to explain MA, when I mentioned copays and networks, she didn't want to hear anymore about MA. She also likes that her healthcare costs will be predictable with a Med Supp and I told her the premium will go up 5-10% a year and if she can pass underwriting, she can switch every few years to get a lower premium.
.
I think there's a place for MA, but there's a lot of people that don't like copays. Some of the old people would rather pay the extra money for a Plan F (even though it's not a good buy), because they don't want to mess with any deductible/bills.

I don't disagree . But when you have a o copay for all drs in and out of network and a $2900 moop it's pretty enticing . Like my dad would never have a mapd . There's a place for everything . But there's no denying mapd growth is exploding and in 10 yrs will be 75% of the mkt .Laws will come were mapd can't deny many claims they do today .

 

[somarco]

My 1st wife's turning 65 and called me to pick my brain.....wanted to compare Med Supp to MA. I tried to be unbiased. I explained how Plan G works. When I started to explain MA, when I mentioned copays and networks, she didn't want to hear anymore about MA. She also likes that her healthcare costs will be predictable with a Med Supp and I told her the premium will go up 5-10% a year and if she can pass underwriting, she can switch every few years to get a lower premium.
.
I think there's a place for MA, but there's a lot of people that don't like copays. Some of the old people would rather pay the extra money for a Plan F (even though it's not a good buy), because they don't want to mess with any deductible/bills.

There is a reason why ice cream comes in chocolate and vanilla . . .

Most folks have been on a managed care plan the last 30 years . . . that doesn't mean they like them, or understand them.

The light bulb went on for me a few months ago when talking with a prospect who had a number of medical conditions. Nothing particularly serious, but chronic, requiring several doc visits per month.

He also likes to travel, domestic and international.

I asked if he would like to hear how original Medicare + supplement works . . . he was open minded, so he agreed.

I explained about the networks and how that type of approach may not be conducive to traveling. He said he had been fighting insurance carriers most of his life, why should Medicare be any different?

Well, since you asked . . .

He opted for the Medigap plan.

The freight train be damned . . .

 

[Yagents]

I don't disagree . But when you have a o copay for all drs in and out of network and a $2900 moop it's pretty enticing . Like my dad would never have a mapd . There's a place for everything . But there's no denying mapd growth is exploding and in 10 yrs will be 75% of the mkt .Laws will come were mapd can't deny many claims they do today .

And less funding for mapd is on the docket. And if mandated to actually pay more claims, what do u thing will be the carrier reaction? More dental benefits? Not

 

[somarco]

And less funding for mapd is on the docket. And if mandated to actually pay more claims, what do u thing will be the carrier reaction? More dental benefits? Not

Maybe cut back on dental but offer more pet food coupons . . .

$0 premium plans have been on the rise over the last few years, about 70% now vs 40% a few years ago. Will funding cutbacks reduce the number of $0 plans going forward? Compensation cuts? Smaller networks? The money has to come from somewhere .. .

 

[Midlevel]

Charlene issue is accurate and NOT MY PROBLEM

What IS my problem is clients getting kicked out of SNFs by MAPD.

Tell the industry to get their own house in order before bitching at us.

And the Under Observation rule is no longer an issue. Docs, hospitals and SNF know how to work the system

Well IT IS YOUR PROBLEM when the nursing homes take advantage of someone on Original Medicare and a Med Sup by running them through rehab like cattle every day. I have seen it myself when my Mother was in the alzheimer's unit. They came daily and wheeled those people out in their wheelchair while their sleeping and 45 minutes later here they come back still with their blanket on and sound asleep. This is part of the reason we see such big increases on Med Sups, no accountability and it's a free for all with Original Medicare. This is a major part of why everyone at SNF and Nursing homes dis Medicare Advantage plans, they don't like being held accountable for anything they do. $$$$$$$$

 

[Cenla Agent]

Since when does MA (or Medicare) cover nursing home stays? But no wonder everyone confuses a SNF with nursing homes when Fortune and Kaiser Health News don't seem to know the difference.