Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare

Health Aff (Millwood). 2020 Aug;39(8):1289-1296. doi: 10.1377/hlthaff.2019.01537.


Millions of older Americans are homebound and may benefit from home-based medical care. We characterized the receipt of this care among community-dwelling, fee-for-service Medicare beneficiaries ages sixty-five and older surveyed in the National Health and Aging Trends Study between 2011 and 2017. Five percent of those surveyed received any home-based medical care between 2011 and 2017 (mean follow-up time per person was 3.4 years), and 75 percent of home-based medical care recipients were homebound. Only 11 percent of the total homebound population (approximately 4.4 million fee-for-service Medicare beneficiaries in 2017) received any home-based medical care between 2011 and 2017. Receipt of home-based medical care was more common among homebound beneficiaries living in metropolitan areas and assisted living facilities, which suggests that geographic factors create operational efficiencies for home-based medical care practices that may improve their financial sustainability within the fee-for-service reimbursement setting. The significant unmet needs of this high-need, high-cost population and the known health and cost benefits of home-based medical care should spur stakeholders to expand the availability of this care.

Keywords: Activities of daily living; Clinical care; Dementia; Fee-for-service; Home and community-based services; Home care; Medicaid; Medicare; Medicare savings program; Older adults; health policy; primary care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living
  • Aged, 80 and over
  • Fee-for-Service Plans
  • Female
  • Home Care Services*
  • Homebound Persons*
  • Humans
  • Male
  • Medicare
  • United States