Home Health Copays Pose Risk to Financially Vulnerable Seniors: Report

Nearly half of all seniors in the United Sates are “economically vulnerable” and could be especially at risk in the event Medicare reinstates copayments for home health beneficiaries, say home health leaders citing new research.

Just under 20 million Americans have incomes lower than 200% of the supplemental poverty threshold, according to an Economic Policy Institute report, and a large portion of these seniors could be significantly impacted by possible entitlement changes resulting from Congressional budget negotiations, says the Partnership for Quality Home Healthcare.

President Barack Obama’s 2014 budget calls for Medicare to institute $100 copayments starting in 2017 for beneficiaries using home health care and would apply to episodes of care requiring five or more visits within a 60-day window that is not immediately preceded by a hospitalization. The cost-sharing requirement could produce up to $730 million.


The oldest Americans, aged 80 and older, are the most financially unstable, and as out-of-pocket health costs increase for seniors, more will fall into the “economically vulnerable” threshold, the EPI report indicates.

“After working hard their entire lives, millions of our elderly are struggling to pay for basic needs,” said Elise Gould, co-author of the report and economist at EPI. “As such, policy makers should consider the dire consequences proposals to restructure these programs would have on our parents and grandparents, shifting more costs unto them when many are barely making ends meet.”

Nearly three-quarters (73%) of Medicare home health beneficiaries have an annual income below the federal poverty level, finds Avalere Health analyses. About 40% of home health users who aren’t also eligible for Medicaid and don’t have other supplemental insurance would likely be responsible for the full out-of-pocket cost associated with a cost-sharing requirement.


“The EPI data underscores the home health community’s concern that re-imposing the repealed home health copayment or otherwise hiking out-of-pocket costs would put low-income beneficiaries at great financial risk,” said Eric Berger, CEO of the Partnership, in a statement. “Such a change would cause taxpayer costs to rise, as poor seniors are forced to return to costly facilities for treatment. That is why we urge lawmakers to instead consider pro-patient solutions such as program integrity reforms that achieve significant savings while protecting America’s greatest generation.”

Written by Alyssa Gerace

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