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2015 ; 34
(6
): 1019-27
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Medicare Advantage Members Expected Out-Of-Pocket Spending For Inpatient And
Skilled Nursing Facility Services
#MMPMID26056208
Keohane LM
; Grebla RC
; Mor V
; Trivedi AN
Health Aff (Millwood)
2015[Jun]; 34
(6
): 1019-27
PMID26056208
show ga
Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage
(MA) plans may reduce unnecessary use of these services. However, large
out-of-pocket expenses potentially limit access to care and encourage
beneficiaries at high risk of needing inpatient and postacute care to avoid or
leave MA plans. In 2011 new federal regulations restricted inpatient and skilled
nursing facility cost sharing and mandated limits on out-of-pocket spending in MA
plans. After these regulations, MA members in plans with low premiums averaged
$1,758 in expected out-of-pocket spending for an episode of seven hospital days
and twenty skilled nursing facility days. Among members with the same low-premium
plan in 2010 and 2011, 36 percent of members belonged to plans that added an
out-of-pocket spending limit in 2011. However, these members also had a $293
increase in average cost sharing for an inpatient and skilled nursing facility
episode, possibly to offset plans' expenses in financing out-of-pocket limits.
Some MA beneficiaries may still have difficulty affording acute and postacute
care despite greater regulation of cost sharing.