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Changes in Home Health Care Use in Medicare Advantage Compared to Traditional Medicare, 2011-2016

Publication Date


Stephen Zuckerman, Laura Skopec, Joshua Aarons, Robert A. Berenson, Judith Feder, and Douglas Wissoker
Urban Institute

Peter J. Huckfeldt
University of Minnesota

September 2020

HTML Version (22 PDF pages)


Medicare beneficiaries who need intermittent skilled care to treat their illnesses or injuries and cannot leave their homes without considerable effort are eligible for home health care benefits. In 2015, 12,346 home health agencies served 3.5 million Medicare enrollees, and these services accounted for approximately 5% of traditional Medicare (TM) spending. Until recently, in TM, home health care providers received a prospective payment for a 60-day episode of care, and payments were adjusted for patients' clinical and functional characteristics as well as the number of therapy visits provided. Prior work has shown that home health providers strategically provided therapy visits and recertified episodes in order to maximize payment under this system, which may not be the most efficient or clinically effective use of home health services. In contrast, Medicare Advantage (MA) have more flexibility in terms of how they pay for home health care. MA plans receive a monthly capitated rate from Medicare for each enrollee and thus have financial incentives to use home health care strategically and efficiently, and potentially to substitute home health for more intensive services. Moreover, MA plans have flexibility to define a network of home health agencies, apply cost-sharing to home health benefits, and manage utilization of home health services. Little research has been conducted on the differences in home health utilization and length of home health spells between MA and TM by admission type, however. This mixed-methods study examines changes in patterns of post-acute and community-admitted home health care use between 2011 and 2016, focusing on differences between MA and TM and across MA contract types. We found that overall, MA enrollees were less likely to use home health care than TM enrollees. This study also found that MA home health users were less likely to have a hospital admission during their home health spell.

This report was prepared under contract #HHSP233201600024I between HHS's ASPE/BHDAP and Urban Institute. For additional information about this subject, you can visit the BHDAP home page at or contact the ASPE Project Officers, at HHS/ASPE/BHDAP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C., 20201;,

DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. This report was completed and submitted on December 18, 2019.

Medicare Beneficiaries
Medicare | Medicare Advantage