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Danger of Copayment on Medicare Home Health Services

  • Published: 2014-11-26 : Author: Partnership for Quality Home Healthcare : Contact:
  • Synopsis: New Commonwealth fund study findings underscore danger of a copayment on medicare home health services.

Main Document

"Home healthcare is recognized as clinically advanced, cost-effective and patient preferred and is currently afforded to 3.5 million seniors nationwide."

The Partnership for Quality Home Healthcare - a leading coalition of home health providers dedicated to improving the integrity, quality, and efficiency of home healthcare for our nation's seniors - today said that a new study by the Commonwealth Fund concluding that many U.S. adults over age 65 struggle with access, coordination and patient-centered care underscores the need to prevent the imposition of a Medicare home health benefit copayment.

The study analyzed older people across 11 countries and found that, "Despite having Medicare coverage, U.S. adults age 65 or older were the most likely to report that cost posed a barrier to care. One-fifth (19 percent) said cost was the reason they did not visit a doctor, skipped a medical test or treatment recommended by a doctor, did not fill a prescription or skipped doses."

In fact, home health beneficiaries are documented as being older, poorer, sicker and more likely to be from a minority population than Medicare beneficiaries as a whole. Data from Avalere Health indicates that 24.4 percent of home health recipients are over age 85 compared to just 12.1 percent of all other Medicare beneficiaries. Notably, 66.2 percent of home health seniors live at or below 200 percent of the Federal Poverty Level compared with just 47.9 percent of all other Medicare beneficiaries.

Additionally, 74.7 percent of seniors who receive the Medicare home health benefit have four or more chronic conditions compared to just 48.5 percent of the general Medicare population. Currently, the Medicare home health benefit does not impose a copayment on its beneficiaries, but many in Congress and the administration are weighing the possibility of saddling a vulnerable population with additional out-of-pocket costs.

"These study findings, coupled with Avalere Health's research into the vulnerability of Medicare home health patients, underscore the risk of re-imposing a copayment on Medicare home health patients," stated Eric Berger, CEO of the Partnership for Quality Home Healthcare. "Congress repealed the home health copayment in 1972 for a very good reason: it failed to reduce healthcare costs and instead drove seniors to higher-cost institutional settings. Re-imposition of such failed policy has the potential to compel poor seniors to forego cost-effective home healthcare simply because they cannot pay."

Another major finding of the study concluded that, "U.S. older adults were much more likely to face financial barriers to care," and "Despite Medicare coverage, older Americans have less protection from health care costs, primarily because of high deductibles and co-payments."

Data from Avalere also notes that nearly 40 percent of non-dual eligible Medicare home health patients do not have additional coverage and would be responsible for the full copayment.

"It's clear from multiple sources that re-imposing a copayment on the home healthcare population could make it impossible for many to continue receiving care in the setting they prefer - their home," added Berger. "Instead of imposing co-payments that target innocent seniors, the Partnership is calling for program integrity reforms that would achieve significant savings while safeguarding patient access to vital home healthcare services."

Home healthcare is recognized as clinically advanced, cost-effective and patient preferred and is currently afforded to 3.5 million seniors nationwide.

The Partnership for Quality Home Healthcare was established to assist government officials in ensuring access to skilled home healthcare services for seniors and disabled Americans. Representing more than 2,000 community- and hospital-based home healthcare agencies across the U.S., the Partnership is dedicated to developing innovative reforms to improve the quality, efficiency and integrity of home healthcare. To learn more, visit

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