AARP: Should Medicare Introduce a Home Health Copay?

A number of proposals call for instituting copayments for Medicare beneficiaries using home health care services and there is a case to make for both advocates and opponents of this idea, says Avalere Health, LLC, a health care public policy and business strategy advisory firm, in an AARP Public Policy Institute Perspective.

On the pro side, imposing a copayment for home health services would likely discourage unnecessary utilization, the Perspective suggests. If Medicare beneficiaries become directly responsible for cost-sharing, they will be more careful in determining whether they actually need to use these services.

People are more likely to use health care services when there is little or no cost-sharing in place, studies find. Home health visits in particular are one of just a few services that are completely covered under Medicare Part B, meaning that beneficiaries are not currently required to make a copayment. 

Usage of home health visits has increased “significantly” in the past 10 years, says Avalere in the AARP Perspective, suggesting a possible overuse of services.

“If cost-sharing were introduced, beneficiaries would have more of an incentive to talk to their provider about the necessity of the services being prescribed,” says the paper.

However, if copayments are introduced, many Medicare beneficiaries will have trouble affording them, Avalere continues, especially as studies show Medicare beneficiaries who use home health services tend to be sicker and poorer than the average Medicare enrollee.

Some proposals would require Medicare beneficiaries without other supplemental coverage to end up paying significantly more for these services, says the Perspective paper. 

“Not everyone can afford these higher costs, and some Medicare beneficiaries may avoid using these services, which may be medically necessary, or seek less appropriate care,” it says.

Read more about both sides of the argument. 

Written by Alyssa Gerace

Alyssa Gerace