Medicare Advantage plan disadvantages for nursing home residents

Medicare Part C, or Medicare Advantage, is an alternative to original Medicare offered by private companies. While it offers benefits excluded from original Medicare, folks needing Medicaid to help to pay nursing home costs face several disadvantages. It’s a confusing mess, but Indiana’s State Health Insurance Assistance Program (SHIP) offers crucial help.

Limited provider networks and high costs

Medicare Advantage plans often restrict healthcare provider options. So, they don’t cover the costs of nursing home care or needed specialists, resulting in high out-of-network costs. This is a big problem for residents in rural areas or those with specific health needs.

Coordinating Medicare Advantage and Medicaid

Under Indiana’s Medicaid rules, balancing benefits between Medicare Advantage and Medicaid can lead to coverage gaps for folks needing nursing home care. A Medicare Advantage plan also complicates Medicaid planning and asset protection, leading to faster asset depletion for Medicaid eligibility.

Complex plans with annual changes

Medicare Advantage plans are complex and change each year. Annual plan review is essential to ensure it still meets your needs.

Referral requirements and delays

Often, Advantage plans require specialist referrals and prior authorization for certain services, leading to delays in care.

Impact on Medicaid benefits

Enrolling in a Medicare Advantage plan could change a resident’s eligibility for Medicaid benefits. The interaction between Medicare Advantage and Indiana’s long-term care Medicaid program can cause reduced coverage or eligibility issues.

Marketing tactics and misinformation

Some plans use aggressive marketing, which can mislead residents about the extent of long-term care coverage.

Prescription drug coverage challenges

Medicare Advantage plans often include drug coverage, but residents may face higher costs or lack of coverage for necessary medications due to complex drug lists and coverage levels.

Indiana SHIP support

Indiana residents can seek help from SHIP, offering free, unbiased counseling on Medicare Advantage plans, Medicaid coordination, long-term care options, and prescription drug coverage. More information is available at https://www.in.gov/ship/ or by calling (800) 452-4800.

Conclusion

Selecting a Medicare Part C plan requires careful consideration of several factors, including limited provider networks, Medicaid coordination, long-term care coverage, plan complexity, authorization delays, Medicaid benefits impact, marketing strategies, and drug coverage. Indiana’s SHIP provides essential support for residents making informed healthcare decisions.

More information

Find more information about this and other topics at www.hawkinselderlaw.com. You can also call us at 812-268-8777.

About the authors

Jeff and Jennifer are Trust & Estate Specialty Board Certified Indiana Trust & Estate Lawyers, and active members of the Indiana State Bar Association and the Indiana Chapter of the National Academy of Elder Law Attorneys (NAELA). Jeff is also a member of the Illinois NAELA Chapter, a Fellow of the American College of Trust and Estate Counsel, and a member of the Illinois State Bar Association. Both Hawkins are admitted to practice law in Indiana, and Jeff Hawkins is admitted to practice law in Illinois.

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