As a family physician with many years of local experience both with office practice and nursing home/rehabilitation facility work, I urge senior citizens to be careful about enrolling in or re-enrolling in Medicare Advantage programs.

It is common for seniors, especially those in poorer health, to need a rehabilitation stay at a nursing home/rehabilitation facility following a hospitalization, say for pneumonia or a hip fracture. It has been many years since Medicare and other insurers paid for prolonged hospital stays, and, as it can take weeks after a serious illness for elderly patients to recover well enough to safely return home, weeks-long stays at nursing home/rehabilitation facilities are common after a hospitalization.

In my experience, Medicare Advantage plans sometimes deny full coverage of these rehabilitation stays, forcing people to return home prematurely (with significant risk of harm and/or burden to family) or to pay expensive out-of-pocket costs. These denials of coverage usually come as a complete surprise to patients and their families.

Although Medicare Advantage plans are appealing because of extensive advertising and their coverage of dental and eye care, be aware that they may not cover expensive care when one has a prolonged illness.

Congress enacted Medicare Advantage plans with the goals of providing better and more efficient health care, passing savings on to taxpayers and patients alike. However, there is reason to suspect that, like much of the for-profit health care industry, these plans profit primarily by “cherry-picking” healthier seniors, and that they neither save taxpayers money nor provide better care.


38 Felt Road