Medicare Advantage Drives Growth in Home Health Care Use, Study Finds
A recent study from the Leonard Davis Institute (LDI) at the University of Pennsylvania highlights evolving trends in home health care utilization among Medicare beneficiaries from 2010 to 2020. The research indicates a decline in home health use among traditional Medicare (TM) enrollees, contrasted with increased use among Medicare Advantage (MA) enrollees, particularly for community-initiated care. However, MA home health episodes tend to be shorter in duration, possibly reflecting plan management strategies such as prior authorizations to contain costs.
Home health care is increasingly significant in supporting older adults outside institutional facilities, fitting preferences for aging in place while addressing post-acute recovery and chronic condition management. The growth of MA plans, now covering over half of Medicare beneficiaries, along with pressures to control healthcare spending and a shift towards home- and community-based long-term care, influence these utilization patterns.
Notably, dual-eligible individuals—those enrolled in both Medicare and Medicaid—did not show significant changes in home health use, potentially due to access to Medicaid-funded home and community services. Conversely, non-dually eligible beneficiaries demonstrated increased home health use, underscoring disparities in long-term care access and reliance on Medicare-funded services.
The study raises important questions about equity, access, and quality in the changing home health landscape amid rapid MA growth. Transparency remains limited regarding service authorization, care planning, and outcome measurement within MA home health programs. As home health increasingly fills gaps in long-term care, there is uncertainty whether care delivery models are truly person-centered or inadvertently shifting burdens to insurers, providers, or unpaid caregivers.
Further investigation is needed to assess whether rising use of home health under MA improves patient outcomes, reduces avoidable hospitalizations, and supports functional needs effectively. The findings have potential regulatory and market implications for policymakers, insurers, and providers aiming to enhance care quality, stability of the home health workforce, and equitable access for older adults across Medicare program types.
This research contributes to broader discussions on creating a comprehensive, integrated long-term services and supports system in the U.S., addressing systemic fragmentation and underfunding in care provided outside institutional settings. It also informs Congressional and regulatory discourse about reimbursement strategies, workforce policies, and program design to better align Medicare home health with the needs of a growing, aging beneficiary population.