13% of Medicare Beneficiaries Have Trouble Paying At-Home Care Bills

The cost of in-home care is rising faster than any other long-term care setting, according to recent data from insurance firm Genworth Financial. With that in mind, it shouldn’t be all too surprising that a sizeable portion of Medicare beneficiaries have a serious problem paying home care bills.

In a national survey of more than 740 seriously ill Medicare beneficiaries, 13% of respondents reported having trouble paying a bill related to home care services. The findings were published earlier this month in the journal Health Affairs.

Often touted as the most efficient and effective form of long-term care, home care’s rising price tag has become a common thread throughout much of 2019. In fact, some industry insiders believe the cost of home care has reached a tipping point, driving older adults to alternative options such as adult day health services.


In 2018, the median monthly cost of full-time home health care reached $4,385, an increase of more than 4.5% compared to the previous year, according to Genworth.

Similarly, when it comes to home care, 44 hours of care per week annually could add up to more than 91% of the median U.S. household’s bring-home pay.

“One-to-one care is getting expensive and — given the number of elderly living longer and longer — that math isn’t adding up,” one home care executive previously told Home Health Care News. “We need to start using technology to increase the number of touches we can have without actually going into the home. Additionally, I think we’re going to see much more group care or community shared-aide services.”


Rising minimum wage laws are partially to blame for increasing care costs, as are the more specialized and costly services many providers now offer to better care for complex patient populations.

Paying for home care may be a struggle for many Medicare beneficiaries, but it’s far from the toughest challenge.

Nearly one in three Medicare beneficiaries struggle to pay for prescription drugs, a reality that has made drug-pricing legislation a priority in Congress. Meanwhile, about a quarter of beneficiaries struggle to pay for hospital bills.

Overall, more than half of the seriously ill Medicare beneficiaries surveyed reported having a serious problem paying a medical bill of any kind. That’s somewhat surprising, Health Affairs researchers noted, because Medicare is often viewed as having strong coverage, with many benefices also having supplemental insurance to fill gaps.

“Given the evidence of Medicare’s popularity among its beneficiaries and its comparatively good financial protection relative to commercial insurance, the extent of financial strain among seriously ill Medicare beneficiaries was notable and should invite further investigation,” they wrote.

In terms of federal health care expenditures, 5% of patients account for nearly half of all national health care spending, with 55% of high-needs patients ages 65 and older, according to the National Academy of Medicine.

“The perception that Medicare works well for most beneficiaries obscures the financial exposure that is concentrated among the seriously ill,” researchers wrote.

Aging in place remains the preference for most older adults, making home care affordability a key issue for health care policymakers moving forward.

The preference is so strong, in fact, that more than one in two adults age 50 and over say they would rather die than live in a long-term care facility, a recent survey from the Nationwide Retirement Institute found.

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