Managed Care Continues Growth Trajectory

3/27/25 The continued growth of Medicare Advantage (MA) in 2024, now covering 51% of the Medicare population with 34.5 million enrollees, has significant implications for home health clinicians. While MA has historically driven expansion in home-based care, the latest trends reveal both opportunities and challenges. The slowdown in MA enrollment growth—just 1.3 million new beneficiaries, down 7% from 2023—may signal shifts in reimbursement policies, regulatory scrutiny, and utilization patterns that could impact home health providers. Notably, traditional Medicare enrollment increased by 200,000 for the first time in years, potentially affecting referral patterns and authorization processes for home health services. Additionally, rising healthcare utilization and financial pressures on MA plans could lead to stricter cost controls and prior authorization hurdles, requiring PTs to stay vigilant in advocating for patient access to care.

Despite these challenges, Medicare Advantage remains a vital force in home health, particularly through Special Needs Plans (SNPs), which saw a 10% enrollment increase in 2024 and captured over half of new enrollees. For home health therapists, this growth underscores the importance of specialized care for high-need populations, including those with chronic conditions and functional limitations. Industry leaders anticipate continued policy support for MA, which could sustain home health demand, but financial sustainability concerns may push insurers to reevaluate reimbursement structures. With 91% of health plan leaders expecting stable or improved MA performance by 2026, home health clinicians should prepare for evolving payer dynamics while advocating for fair compensation and streamlined authorization processes to ensure continued access to essential rehabilitation services.