MA Enrollees Less Likely To Receive Care From High-Quality Home Health Providers

When it comes to Medicare Advantage (MA) versus traditional Medicare, members of the former use less home health care and post-acute care in general.

That’s according to a recent analysis from Kaiser Family Foundation (KFF). The analysis examines 62 studies that look at the experiences of MA and traditional Medicare beneficiaries, including utilization.

Broadly, MA enrollment has been on the rise throughout the decade. In 2010, MA enrollment made up 25% of the eligible Medicare population. Now, it’s almost half of the Medicare population.


Plus, beneficiaries who are eligible for both Medicare and Medicaid make up a growing share of the MA population.

KFF’s analysis examined 34 studies that compared the use of health care services between MA enrollees and traditional Medicare beneficiaries. Of those, KFF looked at 18 that focused on post-acute care and home health care specifically.

“The analyses consistently found that [MA] enrollees had higher utilization of preventive services and lower utilization of post-acute care and home health services,” KFF wrote in the analysis.


When looking at the various studies, home health utilization among MA enrollees was anywhere from 2.4% to 6% lower with MA compared to traditional Medicare.

The analysis also demonstrated that both high-needs and non-high needs MA enrollees were less likely to utilize home health services. Individuals that have three or more chronic conditions and limitations in ADLs are considered high-needs beneficiaries.

Three of the studies KFF based their analysis on looked at home health users and rates of hospitalization. There are lower rates of hospitalization among MA enrollees, but there were inconsistent findings on other outcome measures.

Additionally, MA enrollees were less likely to receive care services from home health providers with the highest quality ratings.

While the analysis doesn’t explain the lower utilization of home health services among MA enrollees, there’s a clue to why this may be happening.

Erin Bliss, the assistant U.S. Department of Health and Human Services (HHS) inspector general, pointed out that, at times, MA plans delayed or denied beneficiaries’ access to care, even when it was medically necessary and met Medicare coverage rules.

“In other words, these Medicare Advantage beneficiaries were denied access to needed services that likely would have been approved if the beneficiary had been enrolled in original Medicare,” Bliss said during a hearing that centered around the MA program in June. “These denials likely prevented or delayed needed care for beneficiaries.”

The analysis also comes at a time when providers recently had the opportunity to express their views on the way MA is currently administered by the U.S. Centers for Medicare & Medicaid Services (CMS).

“CMS is beginning to evaluate the plans more closely in terms of provider relations and approaches to health care delivery for enrollees and how the plans can improve health care services for these beneficiaries,” Mary Carr, vice president of regulatory affairs at NAHC, previously told Home Health Care News.

In their comments, Washington, D.C.-based advocacy coalition Moving Health Home pushed for CMS to urge MA plans to provide access to in-home care through the network adequacy standards.

“The scope could focus on certain specialties where in-home care is appropriate or on specific patient populations who may benefit the most from in-home care such as high-cost, high-need patients,” the organization wrote. “The existing process for requesting an exception to network adequacy requirements should remain for those plans who are unable to offer in-home care, or who believe it is inappropriate for their patient populations.”

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