The Shifting Landscape of Supplemental Benefits

Medicare Advantage plans often distinguish themselves by offering supplemental benefits beyond what traditional Medicare covers. These benefits frequently include home-based care services designed to support independent living and address social determinants of health. The BMA report emphasizes the importance of these supplemental benefits in tackling health disparities and meeting the diverse needs of beneficiaries.

However, the trend in in-home support is troubling. While 99% of MA plans offer at least one supplemental benefit, the availability of dedicated in-home support services has declined from 9% in 2024 to just 6% in 2025. Conversely, offerings focused on independent living, such as bathroom safety devices, have seen a slight increase, rising from 22% to 24%.

This shift coincides with growing concerns within the home health industry. Experts warn that the low reimbursement rates offered by many MA plans, coupled with the increasing penetration of MA into the Medicare market, are creating a “crisis” for providers, particularly non-profit organizations. Home health utilization among MA members has decreased by as much as 63.1% over the past five years, despite the overall increase in MA enrollment. Industry sources cite a 38% reimbursement rate difference between traditional Medicare and Medicare Advantage as the most significant challenge facing home health agencies.

What does this mean for the future of aging in place? If MA plans continue to reduce access to in-home support, will beneficiaries be forced into more costly institutional care settings? And how can policymakers ensure that MA plans truly meet the needs of a diverse and aging population?

The challenges facing the home health sector aren’t limited to reimbursement rates. The American Health Care Association (AHCA) has also voiced concerns about prior authorization requirements and other administrative burdens imposed by MA plans, which can delay or deny necessary care. Furthermore, the Kaiser Family Foundation has highlighted the potential for MA plans to steer beneficiaries towards lower-cost providers, even if those providers don’t offer the same level of quality or access as traditional Medicare.

Frequently Asked Questions About Medicare Advantage and In-Home Care

1. What is Medicare Advantage? Medicare Advantage (MA) plans are offered by private insurance companies approved by Medicare. They provide all Medicare Part A and Part B benefits and often include additional coverage like vision, dental, and hearing.
2. Why are fewer Medicare Advantage plans offering in-home support? The decline in in-home support offerings is likely due to a combination of factors, including low reimbursement rates for home health services and a focus on cost containment by MA plans.
3. How does Medicare Advantage enrollment affect home health utilization? Despite rising enrollment, home health utilization among MA beneficiaries has decreased significantly, suggesting that MA plans may not be prioritizing in-home care.
4. Are there demographic differences in Medicare Advantage enrollment? Yes, Black and Latino individuals, as well as those with lower incomes and dual eligibility for Medicare and Medicaid, are more likely to enroll in MA plans.
5. What are supplemental benefits in Medicare Advantage? Supplemental benefits are additional services offered by MA plans beyond standard Medicare coverage, such as transportation, meal delivery, and home-based care.
6. What is the reimbursement rate difference between traditional Medicare and Medicare Advantage for home health? Industry insiders report a significant 38% reimbursement rate difference, creating financial challenges for home health providers serving MA beneficiaries.