Home health care is a central part of supporting older adults outside institutional settings such as hospitals and nursing homes. Home health can be provided for post-acute care after a hospital stay or initiated in the community to help manage chronic conditions or address short-term skilled needs. Home health agencies (HHAs) provide the care covered under traditional Medicare (TM) and MA plans.

A new study by LDI Executive Director Rachel M. Werner and colleagues found shifting patterns of home health care use over the past decade: Home health use was higher among traditional Medicare enrollees but fell for both community-initiated and post-discharge needs. At the same time, the use of home health is growing among Medicare Advantage enrollees—particularly in the community—but is typically shorter in duration of care compared to those on TM.

These patterns raise important questions about the changing use of home health care, particularly in the setting of rapid MA growth, and whether the differential growth of home health care among MA enrollees impacts outcomes.

In this Q&A, Dr. Werner reflects on the study’s key insights, the evolving role of home health within Medicare, and the broader implications for equity, access, and long-term care policy.

Why were you interested in whether Medicare home health care changes over time?

Werner: Home health care is an important part of Medicare—it enables millions of older adults to receive skilled care at home, which is often more aligned with their preferences and supports older adults seeking to age in place. Home health care has been a commonly used Medicare benefit for decades, but over the last decade, there have been a number of shifts in the health care landscape, which might affect how much home health care is being used. For example, over half of Medicare beneficiaries are now enrolled in MA, there are growing pressures to rein in health care spending, and long-term care has shifted away from institutions and toward home- and community-based settings. Each of these factors could change the provision of home health care. And yet, we know surprisingly little about how the use of home health care has changed over this period of time. Our goal was to provide a clearer picture of how and where home health is being used across different types of Medicare coverage to better inform policy and care delivery.

What differences in home health care use did you observe between Medicare Advantage and traditional Medicare?

Werner: We found diverging home health care use patterns between TM and MA from 2010 to 2020. While TM still accounts for more total use, home health care use among those enrolled in TM generally declined over the decade. At the same time, home health care use increased for those enrolled in MA—but only for home health episodes initiated in the community. 

The reasons for the differential trends between MA and TM are unknown, but several possibilities exist. There has been a rise in in-home risk assessments in MA plans, often used to capture and code for more medical conditions. This may contribute to the increasing use of home health care in MA. In addition, we saw that home health episodes tended to be shorter in MA, which may result from the MA plan’s use of prior authorization and other mechanisms and incentivizes often used by MA to help constrain spending.

We also looked at trends separately by dual-eligible status, as dually eligible individuals have access to home-based care outside of Medicare-funded home health care, including Medicaid-funded home- and community-based services. This may change the likelihood of using home health care. We did not observe significant changes in home health care for those individuals who are dually eligible. However, among non-dually eligible enrollees, home health care use has increased over the past decade, particularly for care initiated in the community.

These trends matter. As home health increasingly fills gaps in long-term care, understanding who’s using it—and how—raises questions about equity, efficiency, and whether beneficiaries are getting the proper care in the right setting.

How is Medicare home health care shaping long-term care policy—and what needs to change?

Werner: The growth of Medicare Advantage is changing how home health care is delivered. However, we still lack transparency around how these services are authorized, how care plans are structured, and whether they improve patient outcomes. Home health care can promote independence and enhance quality of life. But delivering on that promise depends on ensuring access to high-quality care, aligning incentives with patient needs, and ensuring accountability for care—especially as MA plans play a more prominent role in shaping how care is delivered at home.

Home health care may increasingly be used to fill gaps in a long-term care system that remains fragmented and underfunded—especially for those who are not dually eligible and therefore lack access to Medicaid-funded home- and community-based services. As the use of institutional long-term care declines, home-based care is filling in for care traditionally provided in institutional settings. To accomplish this, patients are relying on Medicare-funded home health for short-term recovery and ongoing functional needs. Unpaid caregivers must often fill in the gaps. It is still unclear whether we are moving toward a more person-centered long-term care model or shifting responsibilities onto programs—and families—that may not be equipped to handle them. 

This raises the larger question of how to build what we lack as a nation: a comprehensive system of long-term services and supports.

What’s next for your research on Medicare Advantage and home health care outcomes?

Werner: One of the most pressing next steps is understanding how these changes in home health use—particularly among Medicare Advantage enrollees—affect patient outcomes. We know that MA plans increasingly use home health services, often in shorter episodes and with different provider networks than TM. However, we still do not know whether this care meets patients’ needs, improves their health, or reduces avoidable hospitalizations and institutional stays.

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The study, “Home Health Care Use Among Medicare Beneficiaries From 2010 to 2020,” was published on February 19, 2025, in Medical Care Research and Review. Authors include Seiyoun Kim, Mingyu Qi, R. Tamara Konetzka, and Rachel M. Werner.

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