Could having a Medicare Advantage plan deter a nursing home from accepting a patient?

Have you checked with adult family homes?

Yes, having a Medicare Advantage plan can complicate or delay nursing home placement, depending on the situation. Here’s how:

1. Network Restrictions
Most Medicare Advantage plans have limited networks, and not all nursing homes accept every plan. If the nursing home you want for your mom is out of network, the plan may deny coverage or require prior authorization, causing delays.

2. Prior Authorization Requirements
Medicare Advantage plans typically require approval before covering a skilled nursing facility (SNF) stay. This process can slow things down compared to Original Medicare, which doesn’t require prior authorization for SNF coverage.

3. Skilled vs. Long Term Care
Medicare (and Medicare Advantage plans) only covers short term skilled nursing care. If you’re seeking long term placement in a nursing home for your mom, the Advantage plan’s role may be limited, and Medicaid may need to be involved. Most long term nursing home stays are paid for by Medicaid.

I have a couple of suggestions: Call the Medicare Advantage plan and ask which nursing homes in your area are in network and accepting new residents. Also, ask the nursing home directly if they accept your mom’s Advantage plan and what documentation or steps are needed.

Understanding how Medicare Advantage plans affect nursing home placement can help you navigate the process more effectively and avoid unnecessary delays.
I hope this helps.

Sounds like the SNF is stonewalling you. It is a $ thing for them. Why take a Medicaid patient when you can get private pay @ $9,500/month times 2 residents per room? Holy cats that is $19,000/month for one room times however many rooms they have! Or, the SNF can get guaranteed Medicare payments for short term rehab patients without permanently tying up a bed. As long as senior care continues to be a for profit business these SNFs will play these games and their outrageous price fixed LTC bills will drain the middle class of all their savings and keep the “have-nots” out. Keep pressing them for a reason and get it in writing. Meanwhile, look elsewhere. I am sorry you have to go through this stress. Unfortunately, “what’s in it for me?” is the current American way from the top down.

At this point with the current administration, we really don't know what, how or when benefits may be cut or changed. With staff cuts too, it may be very difficult to even talk to someone in the Medicare Dept. And, then staff may be fired and rehired ... we never know anymore.

You might want to call your representatives (congressperson and Senator).

However you proceed, get everything in writing. Have a paper trail.
Hopefully, you will get some helpful feedback here. I regret that I am not much help.

Gena / Touch Matters

So then it has nothing to do with her Medicare Advantage plan, but it might be connected to the subcontracted Medicaid Long Term Managed Care provider. Medicaid doesn’t provide the services directly …different facilities take different providers. What’s the agency and/or provider handling the home care?

Unfortunately the reality is that most nursing home don't want Medicaid residents. However, if she was in the hospital the social services at the hospital would have better luck because they would know that it is not safe for her to go home.

Is mom over weight, is she ambulatory, walker ,Wchair does it take 2 people to get her up, is she mean, does she yell alot, is she up all night, and or aggressive, is she bossy, does she whine alot can't do anything for herself, does she complain all the time. Does she call you vulgar names, and Is she demanding? If you gave any info to the facility Iike a above. It's to much information and they won't 

Yes. This happened to my next door neighbor about 6 weeks ago.
Age 77. Fell and broke left shoulder and broke right hand. She had to have a shoulder replacement.

I live in Florida in a small city. Most Medicare Advantage rehabs/nursing homes would not accept her for rehab in our small city. Only 1 would accept her. That is where she went. She was thrown out in 4 weeks (wanted to be there 8 weeks.) The doctor's have no say in how long someone can stay in in a rehab that takes Medicare Advantage. That is 100% up to the insurance.

We had problems even getting her admitted into rehab. The insurance wanted her to go directly from her shoulder replacement to home. Mind you she had "0" use of either limb and no one at her home.

Its a fact that Medicare Advantage patients only have a certain number of beds allocated to them in SNFs for REHAB purposes. I ran into that big snafu with my mother when she had a Medicare Advantage plan and needed rehab but suddenly, there was "No room" anywhere. As far as LTC goes, I have no idea.....but you may want to ask that question pointedly.

Good luck to you.

If you are looking at permanent placement in a nursing home, her health insurance won't pay for that.

They only pay for rehabilitation after a hospitalization that meets all the criteria for admission.

Nursing home is paid personally or she needs to apply for long term care Medicaid, not to be confused with Medicare or Medicaid insurance.

Nobody has told you any of this while speaking about placement? Do they think she can self pay?

Be warned that Medicaid requires financial at need as well as medically at need, both require documentation to prove.