“Against Medical Advice”

Too many skilled nursing facility residents are being misled about their rights, and it’s happening for a very simple reason: money. Recent reports show that some SNFs are telling residents they will lose their Medicare coverage if they leave “against medical advice” or before a certain number of days. That claim is false. Residents are not prisoners, and Medicare does not work that way.

Under Medicare rules, residents who leave a SNF to go home or transfer to another facility do not lose their Medicare Part A coverage. If they go home, Medicare can still cover home health services, outpatient care, and related treatment. If they return to a SNF, or move directly to a different one, within 30 days of discharge from the hospital, their Part A coverage can resume. This isn’t a loophole or a gray area. It’s spelled out clearly in the Medicare Benefit Policy Manual.

So why would facilities say otherwise? Because Medicare pays well. SNFs bill Medicare daily, often at rates that now exceed $1,000 per day, and Medicare margins have remained strong for decades. When a resident leaves early, the facility still gets paid for the days care was actually provided. But once that resident is gone, the revenue stops. That creates a powerful incentive to discourage discharge, even if the resident wants to leave or would be safer elsewhere.

Threatening residents with loss of coverage is not just misleading, it’s coercive. Elderly residents are often vulnerable, confused, or recovering from serious illness. When a facility implies they’ll be stuck with massive out-of-pocket costs if they leave, it traps people in places they no longer want or trust. That’s not care. It’s financial pressure disguised as medical advice.

Residents have the right to make decisions about where they live and receive care. Medicare was never meant to be used as a leash to keep people in beds for billing purposes. When facilities blur that line, it’s a reminder of how easily financial incentives can override patient autonomy, and why families need to know their rights before being told a story that simply isn’t true.