Does anyone know if having a Medicare Advantage plan could deter the nursing home from accepting a patient? I have been trying to get my mom into a nursing home for a few months now. She has Medicaid and Medicare Advantage (United Healthcare) and I have submitted paperwork to a nursing home that I am trying to get her into.
I am forced to work with "The Resource Exchange" for much of her care since I am in Colorado. They send out homemakers to help with laundry, dishes, etc. They are also trying to get her an in-home nurse to visit once a week.
My issue is, we don't want an in-home nurse, we need her in a nursing home. She lives alone in a subsidized apartment for seniors, but it is in no way Assisted Living. She recently left the stove on and burnt a pan to the point where the smoke alarms went off and the fire department had to come check it out.
The Resource Exchange recently evaluated her and said that she should be approved once the report was submitted because of her memory alone. However, I am still getting the run around from the nursing home. I really don't want to look for another place as there are not a lot of good choices where I live.
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.
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
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.
Good luck to you.
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.