Medicare covers home health benefits for homebound beneficiaries who need intermittent skilled care. While home health care can help prevent costlier institutional care, some studies have suggested that traditional Medicare beneficiaries may overuse home health care. This study compared home health use in Medicare Advantage and traditional Medicare, as well as within Medicare Advantage by beneficiary cost sharing, prior authorization requirement, and plan type. In 2016 Medicare Advantage enrollees were less likely to use home health care than traditional Medicare enrollees were, had 7.1 fewer days per home health spell, and were less likely to be admitted to the hospital during their spell. Among Medicare Advantage plans, those that imposed beneficiary cost sharing or prior authorization requirements had lower rates of home health use. Qualitative interviews suggested that Medicare Advantage payment and contracting approaches influenced home health care use. Therefore, changes in traditional Medicare home health payment policies implemented in 2020 may reduce these disparities in home health use and spell length.
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Results from this research were presented in a poster at the AcademyHealth Annual Research Meeting in Washington, D.C., June 2, 2019, and in a podium presentation at the Annual Meeting of the American Society of Health Economists in Washington, D.C., June 25, 2019. This study was funded by a contract from the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services (Contract No. HHSP233201600024I_ HHSP23337002T). The views expressed in this article are those of the authors and do not necessarily represent the views of the Office of the Assistant Secretary for Planning and Evaluation, the Department of Health and Human Services, or the Urban Institute.