(For more on the national implications of health care reform on United States Medicare, and information on other Medicare issues, see theabcsofmedicare blog here.)
My public Part C Medicare Advantage plan provider, Massachusetts' Democratic-Party-affiliated Tufts Health Plan insurance company, is apparently1 quietly adding about $1000 to the cost of Worcester County, Massachusetts subscribers getting a knee replacement in 2015. I do not know if this applies to other Tufts customers or to other Massachusett counties or to other Part C plans from other insurance companies in Massachusetts or elsewhere but Tufts -- for 2015 -- seems to have increased the cost of a typical admission to an acute-care rehabilitation facility by about $1000 (from zero to $250 a day for the first five days of admission).
I say this seems to be the case because I can't get a straight answer1. Tufts made a signficant change to its 2015 Evidence of Coverage (EOC) document, the policy, that it did not tell subscribers about in its Annual Notice of Change. Both documents were circulated by Tufts to beneficiaries in September 2015 but it was not possible to see the approximate $1000 difference in rehab benefits from the change document. Instead a beneficiary has to read the 2015 EOC word for word versus the 2014 EOC; conversely Tufts did tell its beneficiaries about trivial changes of $5 in some co-pays.
The problem of figuring out what Tufts is up to is made more difficult because the Medicare bureaucracy is very unclear about the difference between rehabilitation in a skilled nursing faciliy (SNF) and rehabilitation in an acute-care rehabilitation hospital. The difference apparently has nothing to do with the facility2 but involves whether the reason for the rehab is one of 13 conditions -- including knee and hip replacement -- or something else. So -- for example -- a person in an acute-care hospital for three days to receive a knee replacement, who is then moved to a facility for 14 days of rehab, pays $750 co-pay at the hospital (for the hospitalization not including any additional cost to the doctors involved) where the operation took place and $1250 at the rehab facility. In 2014, the beneficiary would only be repsonsible for the first $750. It looks as though if you have to go to the same rehab facility for the same length of time for a broken knee rather than a knee replacement, Tufts would consider the rehab service to have taken place at a SNF instead of a rehab hospital and the copay would only be $200 plus the co-pay for the initial acute care hospitalization.
1I say apparently and "appears to be" becaue I have tried very hard to get a straight answer from Tufts about what this change means. I have failed despite hours on the phone.
2In my town, through my doctor's network, the same facility is supposedly both. It's the old poor farm up on Asylum Street.