Executive Summary: A new analysis from NORC, a nonpartisan research organization at the University of Chicago, finds that patients on Medicare Advantage are more likely to face longer hospital stays and less likely to be discharged to certain post-acute care settings than those on Traditional Medicare. Based on data from 2018 to 2022, the findings follow a Senate report warning that Medicare Advantage plans often use prior authorization — a process requiring insurer approval before care is covered — to delay or deny critical post-acute care services. The NORC report raises fresh questions about whether Medicare Advantage limits patients’ access to medically necessary care.
Post-acute care settings include inpatient rehabilitation, skilled nursing facilities, long-term care hospitals, and home health agencies that offer critical services that help senior patients recover after surgery, illness, or injury. These services play a vital role in helping older adults regain independence, avoid costly hospital readmissions, and delay or prevent placement in long-term care facilities. When patients are denied access to post-acute care, the result is often worse health outcomes and higher medical costs.
Key Takeaway #1: Patients on Medicare Advantage have longer hospital stays than those with Traditional Medicare.
– Evidence: On average, Medicare Advantage patients have a 40% longer hospital length of stay compared to patients on Traditional Medicare. In real terms, this is the difference between seven and five days in the hospital.
Key Takeaway #2: Patients on Medicare Advantage are less likely to get certain follow-up care after leaving the hospital, often missing out on crucial post-acute care services that help patients recover safely and fully.
– Evidence: As of 2022, patients on Traditional Medicare were discharged to advanced post-acute care settings (inpatient rehabilitation facilities, long-term acute care hospitals, and skilled nursing facilities) more often than those on Medicare Advantage.
What Does This Mean?
The data confirms what many on the ground have been reporting: Medicare Advantage plans are increasingly making cost-driven care decisions that delay discharges, extend hospital stays, and steer patients away from the intensive post-acute care they may need to fully recover. This not only puts patient outcomes at risk but also strains hospital capacity and shifts costs back to the health system.
Methodology:
NORC at the University of Chicago analyzed data from Traditional Medicare claims and Medicare Advantage encounter reports spanning 2018 to 2022 to evaluate hospital discharges to post-acute care settings. The analysis focused on three key areas: overall hospital discharges to post-acute care, discharges by specific post-acute care setting, and the length of hospital stays preceding discharge to post-acute care.
For overall discharges, the study examined trends in inpatient hospital discharges and the share that led to post-acute care, segmented by Medicare coverage type. The study also examined discharges by post-acute care settings, including skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals, and home health agencies, by coverage type. Finally, to assess length of stay, NORC analyzed the distribution of inpatient hospital lengths of stay prior to post-acute care discharge, segmented by Medicare coverage type.
Read the full report HERE.