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Study: Nearly Half of Medicare Advantage Beneficiaries Are Unaware of Their Nursing Home Benefits

Nearly half of all Medicare Advantage (Medicare Part C) beneficiaries don’t know whether their plan provides nursing home coverage, according to a recent study published in the Journal of the American Geriatrics Society.  

Researchers analyzed data from the Medicare Current Beneficiary Survey (MCBS) from 2010 to 2016. They found the share of Medicare Advantage plan beneficiaries who did not know if their plan covered nursing home care reached a peak of 45.5% in 2016, compared to 38% of Medicare Advantage beneficiaries in 2010. 

By contrast, the number of beneficiaries who did not know if their plan covered dental care was just 3.4% in 2016, and those who were unaware of their plan’s vision coverage was only 5.9%.

An increasingly large share of Medicare beneficiaries are enrolled in Medicare Advantage plans each year. The July 2020 study suggests that many of these beneficiaries don’t fully understand the benefits offered by their individual plan.

Nursing homes vs. skilled nursing facilities 

Nursing homes have been a hot topic in 2020, as many have been hotspots for COVID-19 infections during the novel coronavirus pandemic. 

The lack of beneficiaries’ awareness about their nursing home benefits may be attributed to popular confusion surrounding nursing homes vs. skilled nursing facilities (SNF) and the Medicare coverage that exists for each. 

  • Skilled nursing facilities provide temporary care for patients who need rehabilitation from a stroke, a fall, surgery or other event and who plan to return home.

  • Nursing homes provide permanent or long-term care and serve as a primary residence. 

Often these facilities are one and the same, as skilled nursing care can be administered in a traditional nursing home. 

Medicare doesn’t cover all nursing home care

Original Medicare (Medicare Part A and Part B, provided by the federal government) does not cover “custodial care” in a nursing home if it’s the only type of care that a beneficiary needs.

Custodial care includes help with activities like dressing, bathing, eating and other personal activities. Custodial care is the type of long-term care that is often delivered in nursing homes.  

Medicare Part A does cover some nursing facility services for beneficiaries who meet qualifying conditions, including services such as:

  • A shared room
  • Meals
  • Skilled nursing care
  • Physical, occupational, nutritional and speech therapy
  • Medical social services
  • Certain prescription drugs
  • Medical supplies and equipment
  • Ambulance transportation

Some Medicare Advantage plans, however, may provide coverage for certain long-term nursing home care services such as bathing, grooming, dressing, laundry, mobility and light housecleaning. Some plans may also cover adult daycare, caregiving, home health care, meal delivery and home improvement projects designed to help the beneficiary age in place. 

Original Medicare and Medicare Advantage plans provide coverage for skilled nursing care, whether it’s performed in a nursing home or at a skilled nursing facility. 

For questions about nursing home or skilled nursing facility coverage or to find a Medicare Advantage plan available near you that offers long-term care benefits, you can call to speak with a licensed insurance agent or use our online plan finder tool to compare Medicare plans.

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