Original Medicare, managed by the federal government, is a health insurance program that covers a portion of the costs for covered services as you get them. However, it’s important to understand that while Original Medicare provides essential coverage, it doesn’t cover everything. This lack of comprehensive coverage can lead to hidden costs and potential wellness risks for beneficiaries.
In nursing homes, patients on Original Medicare, particularly those with Supplement plans, often receive the maximum amount of therapy, regardless of whether it results in any improvements. This is because Original Medicare isn’t actively monitored, allowing nursing homes to administer therapy without oversight. This lack of monitoring can lead to unnecessary treatments and increased costs for patients.
Contrast this with Medicare Advantage (MA) plans, which actively manage patient care. Under MA, a patient’s therapy is closely watched for progression. If there isn’t any progress, the therapy stops, ensuring that patients receive only the care they need and benefit from. This active management of care can lead to better health outcomes and lower costs for patients.
Nursing homes often try to switch patients from MA to Original Medicare with a Prescription Drug Plan (PDP). This switch can leave patients exposed to paying 20% of their medical costs. Unlike MA plans, Original Medicare has no cap on out-of-pocket expenses, which can lead to significant financial burden for patients.
Medicare Advantage: Keeping Nursing Homes Accountable and Clients Healthy
Studies have shown that people on MA are generally healthier. They have fewer hospital readmissions, fewer preventable hospitalizations, and lower rates of high-risk medication use. This is largely due to the active management and monitoring provided by MA plans.
Beyond therapy, nursing homes may have financial incentives to keep patients on Original Medicare. For instance, under Original Medicare, nursing homes can charge for each service provided, leading to potentially higher costs. On the other hand, MA plans often bundle services, which can limit the financial incentives for nursing homes to provide unnecessary care.
MA plans play a crucial role in keeping nursing homes accountable. They require nursing homes to meet certain standards and outcomes, and they monitor the care provided to ensure it is necessary and effective. This active oversight can lead to better patient outcomes and can prevent nursing homes from providing unnecessary or ineffective care.
In conclusion, while Original Medicare provides essential coverage, it comes with hidden costs and wellness risks. On the other hand, MA plans offer managed care, resulting in better health outcomes for beneficiaries. It’s crucial for beneficiaries to understand these differences when choosing their Medicare coverage. This understanding can help them make informed decisions about their health care, leading to better health outcomes and lower costs.