• Do you have any victories you'd like to share for the month of May? Help us celebrate others by posting here.

Medicare Advantage Big Trouble for SNF


GA Medicare Expert
5000 Post Club
As Medicare Advantage continues to penetrate the nursing home market, leaders say that MA plans are depressing margins amid higher costs to run operations. This might lead some operators to contemplate closing, while others will be wiser to hire staff in designated roles to help them negotiate better rates – and exclusions – for managed care contracts.

Data confirms that managed care rates are bringing down margins in the space, with MA plans paying one-quarter to one-third less to SNFs than traditional Fee-for-Service (FFS) Medicare

Traditional Medicare amounts to nearly $600 per resident day in revenue, while managed Medicare is paying out only $468 per day, NIC data shows.

“Medicare Advantage is cannibalizing Medicare Fee-for-Service,” said Zimmet. “I think it’s really important to say that Medicare is what subsidizes Medicaid, and as facilities have less and less [FFS] and more and more Medicare Advantage, that puts more pressure on the Medicaid program.”

Medicare was not originally designed to cover long-term nursing home care. It mainly covers short-term stays in skilled nursing facilities for medically necessary care following a hospital stay. For long-term care, individuals often need to rely on Medicaid, private insurance, or personal funds.