Medicare Advantage vs. Traditional Medicare: How Payment Structures Are Shaping Home Health Outcomes

The type of reimbursement structure in Medicare Advantage (MA) plans is quietly steering the quality and length of home health care for millions of seniors. New research reveals that MA plans imposing strict limits on home health agency visits—dictating quantity and type—can lead to shorter stays for patients, less social work involvement, and a significantly higher rate of hospital transfers compared to episodic payment models and traditional Medicare. While episodic MA contracts allow more flexibility and fewer adverse outcomes, per-visit MA plans burden agencies with red tape and may jeopardize recovery and independence. This shift is happening as MA enrollment overtakes traditional Medicare for the first time, making the stakes higher than ever for patients and providers navigating an increasingly complex and consequential care landscape. More