A recent study suggests that stroke patients enrolled in Medicare Advantage plans may receive lower-quality post-acute care compared to those with Original Medicare. This gap appears more significant for patients who also qualify for Medicaid.
The research, published in JAMA Network Open, analyzed data from over 44,000 Medicare beneficiaries aged 65 and older hospitalized for stroke. Researchers evaluated care quality at inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies using the Centers for Medicare and Medicaid Services (CMS) five-star rating system.
Among patients not eligible for Medicaid, Medicare Advantage enrollees were less likely to be discharged to highly rated skilled nursing facilities (53% vs. 58%) and home health agencies (19% vs. 22%) compared to Original Medicare patients.
The disparities were more pronounced for "dual-eligible" patients (Medicare and Medicaid), with only 42% of dual-eligible Medicare Advantage patients receiving highly rated skilled nursing care, versus 44% of dual-eligible Original Medicare patients. No significant difference was found for care at inpatient rehabilitation facilities.
Potential factors driving this gap include Medicare Advantage plans' narrow provider networks, which can limit access to top-rated facilities, and geographic limitations. Researchers also noted that awareness of CMS quality rating tools is low among patients, caregivers, and providers.
With Medicare Advantage plans now covering over half of all Medicare beneficiaries, this research highlights the importance of investigating the quality ratings of in-network facilities before enrollment, especially for individuals with health conditions that may increase stroke risk.