Medicare
Medicare Advantage members less likely to get into top-rated rehab nursing homes, study finds
A study of 1.45 million hospital discharges found people in Medicare Advantage plans, especially narrow-network plans, were less likely than traditional Medicare patients to enter five-star nursing homes or the one nearest home.
Key facts
- MA members were up to 22% less likely to enter five-star rehab homes.
- Narrow-network members traveled about 8.5% farther.
- Higher-rated homes were more often out of network.
What happened
A study published online November 2 in Health Affairs looked at about 1.45 million hospital discharges to skilled nursing facilities in 2022. About 654,500 of those patients, or 45%, were in Medicare Advantage plans, the private plans that replace traditional Medicare for many older adults. On average, those plans gave members in-network access to 61% of the nursing facilities in their area.
Researchers led by Brown University found that people in plans with the narrowest networks were 22% less likely than people on traditional Medicare to be admitted to a five-star facility, and those in broad-network plans were 13% less likely. Admission rates to five-star homes were 28% for traditional Medicare, 24.5% for the broadest plan networks and 21.8% for the narrowest, Skilled Nursing News reported.
People in narrow-network plans were also 18% less likely to go to the facility closest to home and traveled about 8.5% farther on average. Facilities with higher star ratings and more registered nurse staffing were more often left out of plan networks. The authors noted that federal rules only require plans to include at least one facility within set travel limits, and they suggested regulators look at network quality, not just distance.
What it means for families
Most rehab stays after a hospital visit start with a fast decision, often a day or two before discharge. If your parent is on a Medicare Advantage plan, the list of nursing homes the hospital offers may be shaped by the plan's network, and the closest or highest-rated home may not be on it. Asking early gives you time to compare and push for a better fit.
For example: when a hospital first mentions rehab, ask the discharge planner for the full in-network list, then look up each home's star ratings and staffing before you pick.
New York families can compare star ratings, staffing and inspection results for every New York nursing home on Medicare's Care Compare website, and can call the plan to confirm which homes are in network.
What to do this week
- Ask the hospital discharge planner for your parent's plan's in-network rehab list early.
- Compare each home's ratings and staffing on Medicare Care Compare.
- Call the plan to ask about out-of-network exceptions if the best fit isn't listed.
Sources
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