Copayments Don’t Reduce Home Health Use, Brown University Study Finds

Having to shell out a Medicare copayment might not drive people away from home health. That’s according to the results of a new Brown University School of Public Health study that followed roughly 300,000 seniors who use Medicare Advantage.

“We found no evidence that seniors reduced their use of home health care in response to the copayments,” Dr. Amal Trivedi, a professor in Brown University’s School of Public Health and one of the study’s authors, tells Home Health Care News. “That was true even in plans that instituted higher levels of copayments, and it was true for seniors with lower income.”

Though Congress killed copayments for Medicare home health services decades ago, there’s been recent talk of a resurrection from policymakers on both sides of the aisle — and money is the reason why.


Reduction in home health usage, plus revenues from $100 copayments, would generate $1.3 billion for Medicare over 10 years, according to a proposal from the U.S. Department of Health and Human Services.

Still, there’s no evidence that copayments would lead to such a reduction in usage, the researchers concluded. They studied 18 Medicare Advantage plans that instituted copays between 2007 and 2011 and contrasted them with 18 comparable plans that did not.

When the copayments first kicked in, instead of simply dialing down the coverage they received, many beneficiaries switched to Medicare plans that didn’t have them. This also has been observed by home health agencies serving these types of beneficiaries, National Association for Home Care and Hospice (NAHC) Vice President for Law Bill Dombi tells HHCN.


Though switching to a non-copay plan wouldn’t be possible under an umbrella federal policy, the researchers found little evidence to suggest beneficiaries would reduce their usage to save money.

“It’s very difficult for frail, homebound patients to cut back on their use of these services,” Trivedi said in a press release about the study. “If they were to get their care in other settings, such as nursing homes, there’d be substantial cost sharing there, too. Also a lot of the use of home care is driven by doctors’ decisions.”

However, copayments could potentially push beneficiaries to cut back on non-medical expenses such as food, housing, and transportation, the researchers found.

“When seniors have to pay more for health care…that can have some real consequences,” Trivedi says.

No way to co-pay

The idea of implementing a federal co-pay regulation hasn’t exactly received a warm welcome from home health agencies.

Last July, the Council of State Homecare Associations and the Pennsylvania Homecare Association held a public policy summit in Washington, D.C, partly to push back against proposed regulations like home health care copayment.

“We met with Medicare, CMS, and MACs [Medicare Administrative Contractors] locally,” Constance Morrison, president and CEO of Berks Visiting Nurse Association (VNA), Pottstown VNA and Advantage Home Care, told HHCN last year. “We were able to probe and educate others about things that are coming down the pike in the industry. We were able to lobby, throw tomatoes. There were 19 states represented, and about 130 people representing home care.”

The controversy surrounding copayments started many years before that.

“Congress eliminated the home health copayment in 1972 for the very reasons it should not be resurrected now,” the NAHC wrote in comments to House Ways and Means Committee in 2013. “The home health copayment in the 1960s and the 1970s deterred Medicare beneficiaries from accessing home health care and instead created an incentive for more expensive institutional care.”

In light of the Brown findings, NAHC’s Dombi reiterated the association’s concerns.

“The study does show that seniors avoid the [Medicare Advantage] plan copay cost by dis-enrolling,” he says. “That is a strong indication that if that was not an option, patients would look to other ways to avoid the copay cost, including self-denial of care.”

Written by Tim Regan

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