Home Health Providers Have ‘More Power Than They Did Yesterday’ In MA Plan Negotiations

The expanding reach of Medicare Advantage (MA) plans poses an increasingly challenging landscape for home health providers, necessitating their adept navigation of the evolving reimbursement system to thrive. In 2023, MA plan enrollment surpassed that of traditional Medicare, with over 10 million enrollees added in the past decade. Celebrity endorsements and extensive marketing efforts have significantly contributed to this growth, as highlighted by William A. Dombi, President of the National Association for Home Care & Hospice (NAHC). However, home health providers may face financial implications due to lower reimbursement rates from MA plans compared to traditional Medicare. This situation may lead to potential financial losses and require subsidization from other payers, primarily the shrinking traditional Medicare margin. To operate successfully, providers must establish a strong understanding of their business relationship with MA plans, comprehend their contracts thoroughly, and gather compelling evidence showcasing their value, as emphasized by Dombi.