Dive Brief:
- Medicare Advantage plans covered less intensive post-acute care compared with traditional Medicare without a significant difference in short-term health outcomes, according to a study published last week in JAMA Health Forum.
- The research followed Ohio state retirees after a policy change allowed beneficiaries to switch from a mandatory MA plan. Under traditional Medicare, retirees were more likely to be discharged to more intensive — and costly — inpatient rehabilitation facilities and were less likely to receive skilled nursing facility or home healthcare.
- Though the study’s authors found no changes in 30-day hospital readmissions or mortality, they argued more research was needed to determine long-term health impacts.
Dive Insight:
MA, where the federal government pays private insurers to cover healthcare costs for beneficiaries, has become an increasingly popular choice for seniors, with the plans now covering more than half of the eligible Medicare population.
MA plans can offer supplemental coverage like dental benefits or gym stipends, which can be an attractive draw for potential enrollees.
But MA providers have has come under fire for at times refusing to cover necessary care; one report from the HHS’ Office of Inspector General found some MA organizations denied prior authorization or payment requests even though they met Medicare coverage rules. Some insurers have also faced lawsuits alleging they used algorithms to inappropriately deny rehabilitation care for MA beneficiaries.
Last year, the CMS finalized a rule requiring MA plans to comply with traditional Medicare coverage requirements. Regulators will also force insurers — including MA plans — to make prior authorization decisions within 72 hours starting in 2026.
Since MA payers receive capitated per-enrollee payments, they’re financially incentivized to provide care more efficiently — or potentially cut expensive services like inpatient rehabilitation, researchers wrote in the latest JAMA study.
The analysis, which used Medicare data on more than 4,600 hospitalizations for three conditions that often require intensive rehabilitation, followed an Ohio state benefits change from a mandatory MA plan to subsidies for either supplemental Medicare coverage or an MA plan.
After the policy changed in 2016, most retirees switched to traditional Medicare. The percentage of hospitalizations covered by MA decreased by more than 70 percentage points. Inpatient rehabilitation facility admissions spiked by 9.7 percentage points, while use of only home health or skilled nursing facility care fell by 8.6 percentage points.
Days in the community, or the time spent outside of a hospital or other care facility in the post-discharge period, fell by 1.6 days for Ohio public retirees compared with other Humana MA enrollees in the state.
It’s unclear whether the reduction in intensive post-acute care in MA comes from more active case management — such as matching patients more carefully to the type of care they need — or excluding pricier care unless doctors and patients push hard enough, researchers said.
“Notably, the available benefits documentation for the sponsored MA plan in our study did not mention IRF [inpatient rehabilitation facility] services,” they wrote.
