Home Care Providers Likely to See More Medicare Advantage Opportunities as Enrollment Grows

The Medicare Advantage (MA) program has carved out a larger role in the general Medicare universe over the last several years. The MA piece of the pie is projected to grow even further, giving home care providers plenty of opportunities to step into this space.

The number of beneficiaries who have chosen MA in lieu of fee-for-service Medicare has grown substantially over the last few years, in particular. Between 2019 and 2020, for example, Medicare Advantage enrollment grew by roughly 2.1 million beneficiaries, according to data from the Kaiser Family Foundation.

Today, there are more than 26 million beneficiaries enrolled in an MA plan — or about 42% of the total Medicare program.


Meanwhile, the Congressional Budget Office — a nonpartisan entity that advises Congress on a host of issues — projects that close to 40 million Medicare beneficiaries will be enrolled in an MA plan by 2023. That’s more than half the entire Medicare population. 

“Stakeholders who potentially have not had a lot of experience in MA today, it’s wise to start thinking about Medicare Advantage and its particular aspects, given that a lot of people project that it will be the dominant venue in which people receive services within the next decade,” Matt Kazan, principal at Avalere Health, said Tuesday during the Home Health Care News Medicare Advantage for Home Care Virtual Summit.

Washington, D.C.-based Avalere is a health care consulting firm that specializes in strategy, policy and data analysis for life sciences companies, health plans and providers.


Typically, Medicare Advantage tends to serve a population that is more diverse when it comes to race and economic status, according to Congresswoman Allyson Y. Schwartz, president and CEO of Better Medicare Alliance (BMA).

MA beneficiaries have more social risk factors and tend to be poorer. They are also more likely to be dual eligible, Schwartz noted during the HHCN event

“In addition to the chronic conditions we talk about for all seniors, we also know that for poor seniors, for minority seniors, the instances are even higher,” she said. “You’re really looking at a more diverse population and poor population in Medicare Advantage. [And] they’re achieving the same or better outcomes for those beneficiaries.”

BMA is a community of more than 500,000 beneficiaries and 160 ally organizations supporting MA.

Broadly, Medicare Advantage has become more important in home care since the Centers for Medicare & Medicaid Services (CMS) expanded the scope of supplemental benefits plans can offer in 2018.

CMS has since continued to broaden the parameters of coverage for benefits. The number of plans participating in that expansion has likewise increased.

“I think the first year, there were only about six weeks for plans to sort of figure this out,” Schwartz said. “So 2019 was reasonably understood to be the beginning. But we moved from 2020 to 2021 with 245 plans offering … supplemental benefits to 815 making these options available to over 3 million beneficiaries.”

Overall, MA plans have to focus on balancing three key areas: enrollment, retention and medical ROI.

For home care providers looking to work with plans, it’s important to be able to prove how their care services will be a value-add, according to Kazan.

“It is a case to be made to a plan that either my service will make you attractive as compared to competitor plans in that same market, or if your members use the types of services that I’m offering, I can help them stay out of the hospital and stay out of those unnecessary ER visits,” he said. “Those are really the proxies that plans use.”

In order to prove this, it’s important to have the right data in place.

Providers should also approach negotiations with proposals that communicate “what you will do and why it would matter,” according to Schwartz.

“Anecdotal stories help, but actual data [is important],” she said. “Who the right patients are, how do you identify them, how do you actually make sure that you’re pricing your product in a way that actually works, [in terms of] seeing some benefit back to the insurer, so they can cover the costs.”

Companies featured in this article: