Managed Care Options Impact on Your Rehab

Medicare Advantage Plans, sometimes called “Part C”, “MA Plans” or Managed Care plans.

What impact can Managed care have on your rehab needs?

Many people have opted to join managed Medicare brands to save money monthly, but does it actually save you money in the long run?

In the community these managed care policies have great perks, however, if you need to use your benefits in a nursing facility for rehabilitation, you may be shocked at the lack of support you may get.

Managed care providers have to rely on databases to determine what they are willing to pay, for your short term rehab stay. They will look at how hard you’re working, how much you’ve progressed and what your goals are but these are overshadowed by their calendar of allowed days.

For example; If you get a knee replacement, you may only get 8-9 days in a facility.  If you have pneumonia, you may get 11-13 days.  Rarely do they approve more than 15 days. 

For this reason, therapy providers are limited in how much they can help you. Your therapist may only work on basic care needs (can you put on pants and get to a toilet) instead of a holistic rehab plan (can you get food from the kitchen). 

When people come to a rehabilitation facility, they often tell their rehab team “I have 20 (or even 100) days covered by my insurance”. While this is theoretically true, no one has guaranteed days. 

Your insurance can choose to “cut” your coverage after 3 days for any reason.  The Managed Care company may also determine you qualify for less support, and push for you to MOVE to another facility that is not covered by your insurance (like an assisted living or independent living facility) instead of returning home. 

If you do not have funds for the alternative living options, they expect family to provide extra support or pay privately for agency assist (this can cost YOU more than $20-25 an hour).

Unfortunately, there’s no way for YOU to know if your insurance uses this method.  If you call to ask, they will say “you have 20 days covered at 100% and up to 100 days covered per calendar year”. 

You have options!  Talk to your family and therapy team about insurance options if you feel a change is right for you.

Have more questions? We’d be happy to help!  Contact us at The Anderson for more information.

Nicole Martin OTR/L is a Licensed and Registered Occupational Therapist, and Director of the Therapy Department, at The Anderson Nursing & Rehabilitation Facility. Her passion and desire to help people recover from injuries started at a young age, and she now has 20 years of experience. Nicole has worked with clients ages 6 months to 106 years, in acute care facilities, inpatient rehab, home health care and short term skilled facilities.