Home Care Providers in These States May Be Best Positioned for Medicare Advantage

Medicare Advantage (MA) enrollment is expected to skyrocket in coming years, with more than one-third of Medicare beneficiaries currently signed up. But the pace of the great MA migration may be slower than originally anticipated — and vastly different across state lines.

For home care providers, this means there could be fewer older adults with access to the MA program’s expanded in-home benefits in 2020 and beyond.

In fact, a new issues brief from the Kaiser Family Foundation (KFF) found that — in 2016 — only 29% of new beneficiaries chose to enroll in Medicare Advantage plans during their first year of Medicare eligibility. In 2011, for comparison, 23% of new beneficiaries signed up for MA plans.


San Francisco-based Kaiser Family Foundation is a nonprofit that focuses on national health issues, as well as the U.S. role in global health policy.

To gauge MA enrollment, KFF used claims data from a 5% sample of Medicare beneficiaries from the Centers for Medicare & Medicaid Services (CMS), spanning from 2010 to 2016.

Previously, Medicare experts predicted that baby boomers would migrate toward MA over traditional fee-for-service Medicare because of a greater familiarity with managed care during their working years.


In addition to suggesting MA enrollment may be slower than anticipated, the KFF issues brief also highlighted how there is a huge variation in new beneficiary interest from state to state.

For example, more than 40% of new Medicare beneficiaries signed up for MA plans in Oregon and Minnesota during their first year of eligibility in 2016, while less than 11% of beneficiaries opted for MA in Delaware, Maryland, Vermont, Nebraska and New Hampshire.

That huge difference in Medicare Advantage enrollment figures across state lines is something home care providers need to consider when contracting with plans.

In April 2018, CMS announced that it would include non-medical in-home care as a supplemental benefit for 2019 MA plans. This April, CMS announced that MA plans in 2020 could cover any in-home care services and supports that realistically improve the health of individuals with chronic conditions.

At the start of 2019, only 3% of MA plans opted to offer in-home support services, according to AARP. In a recent Home Health Care News survey of 105 providers of at-home services and supports, 90% of respondents said they anticipate contracting with an MA plan for the 2020 plan year.

One example of a home care provider that has been active when it comes to 2019’s expanded MA benefits is Los Angeles-based 24 Hour Home Care.

The company teamed up with SCAN Health Plan through “Returning to Home,” a post-hospitalization initiative for SCAN’s MA members aimed at preventing readmissions and solidifying the discharge process.

24 Hour Home Care — formerly branded as 24Hr HomeCare — provides professional caregiving services to older adults and individuals with developmental disabilities across California, Arizona and the Dallas metropolitan areas.

Founded in 1977, Long Beach, California-based SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in the Golden State.

CareMore Health, an integrated health care delivery system for Medicare and Medicaid patients, is also contracting with 24 Hour Home Care. A subsidiary of Indianapolis-based Anthem Inc. (NYSE: ANTM), CareMore serves more than 150,000 patients across nine states and the District of Columbia.

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