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Medicare Advantage Plus (MAP)

Understanding Your Medicare Advantage Plus Plan

in a Skilled Nursing Facility (SNF)

What Is a Medicare Advantage Plus (MAP) Plan?

A Medicare Advantage Plus is a type of Medicare Advantage plan (also known as Part C), specifically designed for individuals with both Medicare Parts A and B and Medicaid, and receiving home care. These plans coordinate Medicare and Medicaid benefits under one plan and include MLTC (managed long term care) benefits. It combines: 

  • Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing care, and some home health care.
  • Part B (Medical Insurance): Covers doctor visits, therapies, and medical services.
  • Medicare Part D: Includes prescription drug coverage.
  • Medicaid Benefits: Often provides additional financial assistance for premiums, co-pays, and services not covered by Medicare, such as home care and transportation. 

Because Medicare Advantage plans are managed by private insurers, they operate with specific coverage rules and provider networks.

  • Prior Authorization Is Required
  • Your plan requires prior approval for many services in the facility, including admission, therapies, tests, medical equipment and length of stay at the facility. 
  • Without prior authorization, services will be denied, and you would be responsible for the cost of care at the facility.
  • Costs and Coverage
  • Coverage for skilled nursing care follows Medicare’s basic structure:
    • Days 1–20: Covered by your Medicare Advantage Plus plan
    • Days 21–100: $0 copay, provided you have Qualified Medicare Beneficiary (QMB) Medicaid or Nursing Home Medicaid.  
    • After Day 100: You’re responsible for the full cost, unless you have Nursing Home Medicaid. 
  • Prescription Drug Coverage
  • Medicare Advantage Plus plans include drug coverage. All medications administered at the facility are covered as long your insurance approves your stay. 

Your Options:

  • Stay with Your Medicare Advantage Plus Plan
  • Medicaid helps reduce costs, and your care is managed by the plan.
  • Be aware of prior authorization requirements and check that all services are covered under your plan.
  • Switch to Original Medicare + Medicaid*
  • Contact your Plan Carrier: Before making any changes, understand how switching plans may impact your integrated Medicaid/managed Long Term Care services. Any changes will likely result in loss of home care services. If you would like to leave the MAP plan you will need to enroll in a new MLTC plan by the 15th of the month and your MLTC coverage will begin the following month.
    • Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing care, hospice and some home health care. Deductibles and copays apply. Medicaid will cover the deductibles and copays in the hospital.
    • Part B (Medical Insurance): Covers doctor visits, outpatient services, therapies, and medical services. Non-preventative services covered up to 80%. Medicaid will cover the remaining 20% coinsurance. 
    • Prior authorizations are not required. (For skilled nursing care/rehab and otherwise).
    • Original Medicare gives up to 100 days for skilled nursing care.
      • Length of stay is determined based on your medical needs and the interdisciplinary team at the facility. 
      • Days 1-20: Fully covered by Medicare
      • Days 21–100: $0 copay, provided you have Qualified Medicare Beneficiary (QMB) Medicaid or Nursing Home Medicaid.  
      • After Day 100: You’re responsible for the full cost, unless you have Nursing Home Medicaid. 
  • All medications administered at the facility are covered by Medicare Part A. 
  • Next Steps:
    • Enroll in a Medicare Part D drug plan to disenroll from your Medicare Advantage Plus plan. 
    • Medications will be covered by your Part D drug plan post your skilled nursing care stay. 
      • Out-of-pocket costs will be covered by the federal ExtraHelp program (through your Medicaid qualification).

*You qualify for a Special Enrollment Period (SEP) to make plan changes. Changes can be made for as long as you are in the facility and for an additional two months after the month you leave the facility.