Changes to Medicare Advantage plans could result in many nursing homes seeing lower reimbursements for patients in 2025.
Rate adjustments affect seniors and their health care providers each year, whether they’re on traditional Medicare or the privatized Medicare Advantage plans.
The lower reimbursements will start impacting nursing homes next year, as base payments on Medicare Advantage plans were cut by an average of 0.16 percent for 2025 by the Centers for Medicare and Medicaid Services.
The news arrives as the Biden administration looks to make Medicare Advantage payments more accurate and provide insurers more money based on the number of documented health issues a patient has.
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Altogether, Medicare Advantage plans will grow by an average of $16 billion, or 3.7 percent, in payments, according to the Centers for Medicare and Medicaid Services.
Today, more than half of America’s Medicare enrollees are covered by Medicare Advantage, which can often provide lower out-of-pocket costs initially but is often limited to a certain network of providers or treatment options.
This issue is heightened for seniors in nursing home care, said Christopher Westfall, founder of the Senior Savings Network.
“Medicare Advantage routinely and systematically already denies care to skilled nursing care when original Medicare has no such problem,” Westfall told Newsweek. “To the extent that a miniscule reimbursement cut to MA, overall, affects all areas, they will use this excuse to deny even more care in the skilled nursing area.”
Among the other changes in store for Medicare in 2025, the Centers for Medicare and Medicaid Services said it would be setting more clear compensation amounts for agents and brokers. It would also be limiting the personal beneficiary data distributed by third-party marketing organizations to better protect patients’ private information.
Seniors previously complained that they’ve been targeted with an influx of cold calling and marketing schemes that have led them to sign up for plans they might not have chosen otherwise.
Medicare Advantage plans will also be required to send out mid-year enrollee updates of unused supplemental benefits.
“This Medicare Advantage benefits cut will result in the 2.8 million Florida seniors currently enrolled in Medicare Advantage, many of whom live on a fixed income, having their supplemental benefits reduced by $33 per month, or $396 per year,” Senator Rick Scott, a Florida Republican, said in a statement last week.
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Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.