Copayments – The Next Issue of Contention for the Home Healthcare Market?

Thanks to Medicare, 3.5 million seniors in America are able to receive medical services in the comfort of their own homes.  Until 2030, another 10,000 Baby Boomers will be turning 65 years old each day, which equates to an increasing number of Medicare beneficiaries and patients of home healthcare services.  According to Medicare data, home healthcare is the least expensive form of care for a variety of chronic conditions.  Keeping seniors out of inpatient locations and hospitals saves Medicare an enormous amount of money each year.

However, there has been a recent proposal in Washington to reinstitute copayments for home healthcare services.  These copayments were abolished originally over 40 years ago in 1972.  It was not a good idea then and still is not a good idea today.

With the new copayment plan, seniors would be required to pay $100 per every 60 days of service.  The implementation of these copayments will not help with rising Medicare costs, but actually hinder it.  Instead seniors will choose the more expensive care option, which does not require a copayment.  In addition to costing more, there are several other reasons why copayments should not be enforced again:

  • Over their lifetime, seniors already have paid into the Medicare program and the U.S. tax system so they should not be required to contribute again.
  • Medicare beneficiaries many times are the most vulnerable patients.  They are elderly and very sick as well as have low incomes.  They do not have the disposable income necessary for copayments.
  • Medicare beneficiaries already spend on average 37% of their out-of-pocket income on healthcare expenses.

Copayments could be reintroduced as early as 2018, but more likely they will be reinstated in 2020 per President Obama’s 2017 plan.  However, the copayment only applies to newly eligible Medicare beneficiaries starting with the year of implementation.  The Affordable Care Act (ACA) caused the copayment initiative to rise to the surface again.  Even though it may not seem to be the best idea per the points above, it may result in one good thing – Medicare beneficiaries becoming more involved in their own care.  Since they do have some “skin in the game” with copayments they are more likely to follow care directions.  However, paying this bill most likely will be one of their lowest priorities.

Many new programs and policies have been put in place recently that have impacted the home healthcare market negatively.  Don’t let copayments be the next one.  Talk with your government officials at both the state and national levels as well as homecare associations.  Home healthcare agencies need to voice their concerns to ensure the best type of care is available to every patient.

“Copayment Woes Drive Agenda for Home Care Advocates”, Amy Baxter, August 22, 2016 Home Health Care News
“Medicare Home Health Care Copayment”, website

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