Medicare Expansion Would Have Limited Impact on Home Health Providers

More than half of large employers in the U.S. are in favor of expanding Medicare to Americans under 65 — a change that, if implemented, could give government-reimbursed home-based care providers access to more patients.

That’s according to a study from the National Business Group on Health, first covered in Forbes. The survey included responses from more than 147 large employers from a variety of industries, together covering more than 15.6 million employees and their dependents.

More than 54% of respondents belong to the Fortune 500, while 39 belong to the Fortune 100, according to the National Business Group on Health.

Of the respondents, 23% supported Medicare expansion for seniors age 60 to 64, while another 23% supported an expansion that would allow Medicare to cover Americans starting at age 50. Currently, only seniors age 65 and up are eligible for Medicare.

While the survey results are merely fodder, an expansion of Medicare to cover younger seniors could mean more business for home health providers, whose services are reimbursed by Medicare. However, that impact would likely be “limited,” according to National Association for Home Care & Hospice (NAHC) President William A. Dombi.

“An expansion of Medicare to a younger population would have limited impact on home health services, as services are primarily used by the Medicare population with permanent disabilities and those enrollees 75 years and older,” Dombi told Home Health Care News in an email. “However, as home care expands with an innovative population-health focus, younger enrollees are likely to utilize services as pre-acute and acute-episode alternatives to inpatient care.”

While non-medical home care has historically not been covered by Medicare, many services may now be covered under certain Medicare Advantage (MA) plans. The Centers for Medicare & Medicaid Services (CMS) has expanded those supplemental benefit flexibilities two years in a row, and many industry insiders predict more leniency in the years to come.  

If Medicare were to ever expand to cover younger seniors, the federal government would likely need more money to make it happen.

The Medicare Hospital Insurance (HI) Trust Fund — which helps fund stays in hospitals, skilled nursing facilities, hospices and the use of home health services under Part A — is projected to run out by 2026, according to CMS’s Office of the Actuary.

Meanwhile, the Medicare Supplementary Medical Insurance (SMI) Trust Fund — which helps fund physician, outpatient hospital and additional home health services, as well as subsidized access to drug insurance — had $104 billion in assets at the end of 2018 and will not run out because of how the trust is set up, the same report suggests.

In 2019, home health spending is projected to hit $108.8 billion, according to the CMS Office of the Actuary. By 2027, home health care expenditures are projected to jump to $186.8 billion.