Medicare Advantage Beneficiaries Receive Less Home Healthcare Services

Medicare Advantage beneficiaries received shorter and less intensive home healthcare services than those in traditional Medicare, a study published in JAMA Health Forum found.

The Medicare home healthcare benefit provides nursing, rehabilitation, home health aides, and medical social work services. Receiving home healthcare services has been associated with lower mortality, reduced hospital readmissions, and functional improvement.

Under the current payment policy, traditional Medicare beneficiaries are certified for 60-day home health episodes, and agencies are reimbursed for 30-day payment periods. Rates are based on patient characteristics, period timing, and admission source. Meanwhile, Medicare Advantage plans often require prior authorization or recertifications for home healthcare services.

Researchers used administrative data from a national non-profit home health company to assess differences in home healthcare intensity and patient outcomes between Medicare Advantage and traditional Medicare beneficiaries following a home health admission between 2019 and 2022. The analysis included data on 107,102 Medicare Advantage beneficiaries and 178,195 traditional Medicare beneficiaries.

Medicare Advantage beneficiaries were younger, more likely to be admitted from the hospital, had lower medical risk, and less impairment in self-care and mobility at admission compared to those in traditional Medicare.

Individuals in Medicare Advantage were also more likely to live alone, less likely to have around-the-clock support at home, and more likely to live in rural and disadvantaged areas.

Medicare Advantage beneficiaries had shorter home health lengths of stay, defined as the number of days between admission and discharge from home health. Patients in Medicare Advantage had a mean home health length of stay that was 1.62 days shorter than those in traditional Medicare, translating to a 3.5 percent shorter length of stay.

Additionally, Medicare Advantage beneficiaries received 4.9 percent fewer nursing visits, 2.7 percent fewer physical therapy visits, 2.9 percent fewer occupational therapy visits, 5.0 percent fewer speech therapy visits, and 5.0 percent fewer home health aide visits.

Beneficiaries in Medicare Advantage were 3 percent and 4 percent less likely to improve in mobility function and self-care function than traditional Medicare beneficiaries. They were 5 percent more likely to be discharged to the community than those in traditional Medicare.

High rates of community discharge coupled with reduced functional improvement could lead to caregiver burden and adverse health outcomes, especially for beneficiaries living alone. Future evaluation of programs and policies that disincentivize home healthcare utilization, including Medicare Advantage, should consider functional outcomes, researchers recommended.