Category: Nursing Home

Tips on how to keep from going broke from nursing home expenses

Nursing home

Millions of elderly people in the U.S. are currently living in nursing homes. Most of them don’t have a lot of money and they can’t afford to live anywhere else and receive the care that they need due to chronic  illnesses such as stroke, dementia and Parkinson’s disease. Fortunately, most of those costs are paid by the government through the Medi-Cal program in California or Medicaid a it is  referred to in other states.

But what happens when an individual ends up in a nursing home because they need the level of skilled nursing care that can only be provided in such a facility but have assets to pay for that care? At first glance this does not seem to be a problem. However, if there is a well spouse at home, he or she will pay between $8000.00-$12,000 a month potentially bankrupting him/her and leaving that well spouse with little or no money to care for themselves.

It is precisely because of this situation that many Californians turn to Elder Law Attorneys to make sure that they qualify for Medi-Cal in advance so that should the need for Medi-Cal arise they will be prepared. Attempting to spend assets down to an acceptable amount  for eligibility ($2000 in non exempt assets for a single applicant and $124,429 in on exempt assets for a couple) at the last minute can be expensive and decrease the chances that the application will be accepted.

 

 

 

 

 

Are Medicare Advantage Plans Steering Enrollees to Lower-Quality Nursing Homes?

A new study has found that people enrolled in a Medicare Advantage plan were more likely to enter a lower-quality nursing home than were people in traditional Medicare. The study raises questions about whether Medicare Advantage plans are influencing beneficiaries’ decisionmaking when it comes to choosing a nursing home.

Medicare Advantage plans, an alternative to traditional Medicare, are provided by private insurers rather than the federal government. The government pays Medicare Advantage plans a fixed monthly fee to provide services to each Medicare beneficiary under their care, and the services must at least be equal to regular Medicare’s. While the plans sometimes offer benefits that original Medicare does not, the plans usually only cover care provided by doctors in their network or charge higher rates for out-of-network care.

The study, conducted by researchers at Brown University School of Public Health, examined Medicare beneficiaries entering nursing homes between 2012 and 2014. Using Medicare’s Nursing Home Compare website as the measure of quality, the study found that beneficiaries in Medicare Advantage plans tended to enter lower quality nursing homes than beneficiaries in original Medicare. This was true even when the researchers took into account the beneficiaries’ distance from the nursing home and other decision factors. Even beneficiaries enrolled in highly rated Medicare Advantage plans were more likely to enter a low-quality nursing home compared to original Medicare beneficiaries.

The study does not draw any conclusions about whether the Medicare Advantage beneficiaries fared worse than original Medicare beneficiaries, only that they tended to enter facilities that had higher re-hospitalization rates and worse outcomes. The study concluded that Medicare Advantage plans may be influencing beneficiary decisionmaking around nursing home selection. According to Skilled Nursing News, one of the study’s authors speculated that a Medicare Advantage plan “might be incentivized to send patients to a given nursing home regardless of what the quality ratings are, because of a relationship with that nursing home or because they have a lot of patients in that nursing home and can better manage their care.”

Information on exactly why this is happening is “of vital policy importance,” according to the study’s authors. They recommend gathering more information about Medicare Advantage nursing home claims and re-hospitalization rates and requiring Medicare Advantage plans to be more transparent about the quality of nursing homes in their networks.

To read the study, which was also published in the January issue of the journal Health Affairs, click here.