Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans

Abstract

OBJECTIVES To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF). DESIGN Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008–2012. SETTING Select MA plans. PARTICIPANTS Members of 27 plans with mandatory cost sharing reductions (n=132,000) and members of 21 plans without such reductions (n=138,846). MEASUREMENTS Mean monthly number of SNF admissions and days per 1,000 members; annual proportion of MA enrollees exiting the plan. RESULTS In plans with mandated cost sharing reductions, cost sharing for the first 20 days of SNF care decreased from an average of $2,039 in 2010 to $992 in 2011. In adjusted analyses, plans with mandated cost-sharing reductions averaged 158.1 SNF days (95% confidence interval (CI)=153.2–163.1 days) per 1,000 members per month before the cost sharing cap. This measure increased by 14.3 days (95% CI=3.8–24.8 days, p=0.009) in the 2 years after cap implementation. However, increases in SNF utilization did not significantly differ between plans with and without mandated cost-sharing reductions (adjusted between-group difference: 7.1 days per 1,000 members, 95% CI=−6.5–20.8, p=.30). Disenrollment patterns did not change after the cap took effect. CONCLUSIONS When a federal regulation designed to protect MA members from high out-of-pocket costs for postacute care took effect, the use of SNF services did not change.

Preferred Provider Relationships Between Medicare Advantage Plans and Skilled Nursing Facilities Reduce Switching Out of Plans: An Observational Analysis

“…In addition, because there is large variation in cost-sharing, plan benefits, and size/quality of provider networks, a patient may find another MA plan to be more appropriate based on the SNF care experience. [40][41][42][43] Because we focused on MA enrollees who thought that MA would be more appropriate than TM to begin with, most of the MA beneficiaries remained in MA.…”

Variation in influenza vaccine assessment, receipt, and refusal by the concentration of Medicare Advantage enrollees in U.S. nursing homes

“…MA plans and the characteristics of their enrollees have changed over time, as has the population of individuals receiving care in NHs. [20,21] The composition of MA beneficiaries in a NH and its relationship with the proportion of residents vaccinated has not been characterized. Yet, this is an important lens through which to examine and address gaps in influenza vaccination coverage in NHs, especially as MA plans may be selectively contracting with NHs, such as those that are larger and are part of a chain.…”