Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

OBJECTIVES

To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF).

DESIGN

Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008-2012.

SETTING

Select MA plans.

PARTICIPANTS

Members of 27 plans with mandatory cost sharing reductions (n=132,000) and members of 21 plans without such reductions (n=138,846).

MEASUREMENTS

Mean monthly number of SNF admissions and days per 1,000 members; annual proportion of MA enrollees exiting the plan.

RESULTS

In plans with mandated cost sharing reductions, cost sharing for the first 20 days of SNF care decreased from an average of $2,039 in 2010 to $992 in 2011. In adjusted analyses, plans with mandated cost-sharing reductions averaged 158.1 SNF days (95% confidence interval (CI)=153.2-163.1 days) per 1,000 members per month before the cost sharing cap. This measure increased by 14.3 days (95% CI=3.8-24.8 days, p=0.009) in the 2 years after cap implementation. However, increases in SNF utilization did not significantly differ between plans with and without mandated cost-sharing reductions (adjusted between-group difference: 7.1 days per 1,000 members, 95% CI=-6.5-20.8, p=.30). Disenrollment patterns did not change after the cap took effect.

CONCLUSIONS

When a federal regulation designed to protect MA members from high out-of-pocket costs for postacute care took effect, the use of SNF services did not change.