Many people are not aware that Medicare covers home health care for people who are homebound and need skilled nursing services on an intermittent basis or skilled rehabilitation services. The benefit is designed to help people who otherwise would struggle to live independently. But, while the home health benefit is important in theory, it has become harder to get in practice.
Everyone with Medicare, be they in traditional Medicare or Medicare Advantage is entitled to home health services if they meet the eligibility criteria. But, as with many costly benefits, insurers offering Medicare Advantage often deny people home health coverage or provide fewer home health visits and limited coverage .And, Medicare Advantage insurers pay less for home care than traditional Medicare. In sharp contrast, people in traditional Medicare who qualify for coverage can get it, but they need to find a Medicare-certified home health agency to provide the care.
N.B. Medicare Advantage insurers often do “home visits.” This is very different from home health care. They have a financial incentive to do home visits because it enables them to add diagnosis codes to patient records and generate higher Medicare payments.
As usual, the way Medicare pays for a service determines how accessible the service will be. Because Medicare Advantage insurers are paid a flat rate per enrollee adjusted for their health conditions, the insurers have a financial incentive to deny home health care. It’s expensive. And, the less the insurers spend on enrollees’ care, the more they profit.
In traditional Medicare, the latest findings reveal that people with acute care needs are most likely to get coverage for Medicare home health care, including skilled nursing services, rehab services and home health aide services to help with bathing, dressing and toiletting, among other daily tasks. Short and limited home health care services are where the home health care providers maximize revenue.
A new Commonwealth Fund paper recommends that Medicare pay higher rates for home health care. It also recommends the expansion of the home health workforce and caregiver support. It suggests that Medicare change the way it pays home health agencies so that they do not earn less income when treating people with chronic conditions who need home health care over a long stretch of time. Without this change, people with chronic conditions, including people with cognitive impairments, behavioral health needs and long-term needs are likely to suffer.
Here’s more from Just Care:
- Traditional Medicare offers better home care benefits than Medicare Advantage
- Medicare coverage of nursing home care is very limited
- Roundup: Housing options for older adults
- Home visits: Another way Medicare Advantage plans gouge taxpayers
- Need for more home care workers to care for older adults at home
