This change, driven by CMS rate reductions and new out-of-pocket limits, is causing concern as there’s no central database to verify co-pay amounts, leading to difficulties in timely collections. The lack of transparency and varying co-pay structures across the 3,719 MA plans complicate billing processes, potentially leaving providers with uncollected debts.
An increasing number of Medicare Advantage insurers are expected to institute nursing home co-pays starting Jan. 1, a change that could further hit providers already struggling to collect fair reimbursement from the plans.
While Medicare charges a co-pay starting on Day 21 of a skilled nursing stay, reports are mounting that many MA plans are adding co-pays starting on the day of admission during 2025.
“Anecdotal evidence from providers indicates a growing trend toward shifting more cost-sharing responsibility to patients. The exact prevalence will likely vary regionally and by plan,” said Kristy Brown, director of SNF strategy for Quality Healthcare Resources.
O’Connor, J. (2024, December 13). Expanding Medicare Advantage co-pays may leave nursing homes without cash they’ve earned – McKnight’s Long-Term Care News. McKnight’s Long-Term Care News. https://www.mcknights.com/news/expanding-medicare-advantage-co-pays-may-leave-nursing-homes-without-cash-theyve-earned/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
