MAPD Plans’ Role in Managing Hospital Stays and Skilled Nursing Care

Medicare Advantage plans, also known as Medicare Part C, offer an alternative to traditional Medicare by providing additional benefits and services. One crucial aspect of these plans is their role in managing hospital stays and skilled nursing care. In this blog post, we will explore how Medicare Advantage plans contribute to ensuring high-quality care during hospitalizations and skilled nursing facility stays. We will discuss the coverage options, care coordination, and the benefits that these plans offer, providing a comprehensive understanding of their role in managing these critical healthcare needs.

Understanding Hospital Stays and Skilled Nursing Care 

Hospital stays and skilled nursing care play a significant role in a person’s healthcare journey. During a hospitalization, individuals receive acute medical care and treatment for various conditions. Skilled nursing care, on the other hand, involves specialized care provided by licensed professionals in a skilled nursing facility (SNF) after a hospital stay. This care is aimed at helping individuals recover, regain their strength, and transition back to their homes.

Coverage and Benefits of Medicare Advantage Plans 

Medicare Advantage plans provide coverage for both hospital stays and skilled nursing care. They typically include the benefits of Original Medicare (Part A and Part B) and may offer additional services such as prescription drug coverage (Medicare Part D), dental, vision, hearing, and wellness programs.

For hospital stays, Medicare Advantage plans cover inpatient hospital services, including room and board, doctor visits, surgeries, lab tests, and medications administered during the stay. These plans often have predetermined copayments or coinsurance amounts for specific services.

In the case of skilled nursing care, Medicare Advantage plans cover the first 100 days of care in a skilled nursing facility following a qualifying hospital stay. This coverage includes room and board, nursing care, physical therapy, occupational therapy, speech therapy, and necessary medical supplies.

Care Coordination and Case Management 

One of the key advantages of Medicare Advantage plans is the emphasis on care coordination and case management. These plans have a network of providers and care teams who work together to ensure seamless transitions between hospital, skilled nursing facility, and home care settings.

Care coordination involves a multidisciplinary approach to healthcare, where healthcare professionals collaborate to create a comprehensive care plan tailored to the individual’s needs. Medicare Advantage plans often assign care managers who serve as a point of contact, helping to coordinate services, appointments, and ensuring continuity of care.

During hospital stays, care managers can work closely with healthcare providers to monitor the individual’s progress, address any concerns, and facilitate post-discharge planning. They may arrange for home health services, rehabilitation therapies, or other necessary follow-up care.

Similarly, during skilled nursing facility stays, care managers can oversee the individual’s care, ensuring that the provided services align with the prescribed treatment plan. They can also collaborate with the facility’s staff to monitor progress, update care plans, and facilitate the transition back home when the time is right.

Benefits of Medicare Advantage Plans in Managing Hospital Stays and Skilled Nursing Care 

Medicare Advantage plans offer several benefits that can significantly impact the management of hospital stays and skilled nursing care. These benefits include:

Enhanced Care Coordination:

Medicare Advantage plans have care teams dedicated to coordinating care, reducing gaps, and ensuring smooth transitions between healthcare settings.

Expanded Coverage:

In addition to hospital and skilled nursing care, Medicare Advantage plans often provide coverage for services like prescription drugs, preventive care, and specialized therapies, offering a more comprehensive approach to healthcare.

Cost Predictability:

Medicare Advantage plans typically have predetermined copayments or coinsurance amounts, providing individuals with greater cost predictability for hospital stays and skilled nursing care.

Extra Services:

Medicare Advantage plans may offer additional services beyond what Original Medicare covers. These extra services can include prescription drug coverage, dental care, vision care, hearing aids, transportation services, fitness programs, and even meal delivery. By incorporating these additional services, Medicare Advantage plans aim to address the holistic needs of individuals during hospital stays and skilled nursing care.

Prescription Drug Coverage:

With prescription drug coverage, individuals can receive necessary medications during their hospitalization or skilled nursing facility stay, ensuring continuity of care and reducing out-of-pocket expenses. Dental, vision, and hearing benefits can play a crucial role in maintaining overall health and well-being, as oral health, clear vision, and good hearing contribute to a person’s quality of life.

Transportation

Transportation services provided by some Medicare Advantage plans can assist individuals in accessing necessary medical appointments, follow-up visits, or transitioning between healthcare settings. This service is particularly valuable for those who may have mobility challenges or limited access to transportation.

Many Medicare Advantage plans also offer fitness programs or wellness benefits, promoting physical activity and preventive care. These programs can help individuals maintain their health, prevent complications, and support their recovery process during and after a hospital stay or skilled nursing care.

Conclusion

Medicare Advantage plans play a vital role in managing hospital stays and skilled nursing care, offering comprehensive coverage, care coordination, and additional benefits beyond Original Medicare. With a focus on care management and multidisciplinary collaboration, these plans ensure that individuals receive high-quality and coordinated care throughout their healthcare journey. By providing coverage for hospital stays, skilled nursing care, and a range of extra services, Medicare Advantage plans enhance the overall experience and outcomes for individuals during these critical periods of their healthcare needs.