Medicare recipients could see a new out-of-pocket charge for home health visits if Congress follows through on a recommendation issued Thursday by its own advisory panel.
Until now, home health visits from nurses and other providers have been free of charge to patients, but the Medicare Payment Advisory Commission says a copayment is needed to discourage overuse of a service whose cost to taxpayers is nearing $20 billion a year. Medicare charges copays for many other services, so home health has been the exception, not the rule.
The advisory panel did not prescribe an amount, but its staff has suggested the charge be $150 for a series of related visits.
The congressionally appointed commission voted near unanimously by a show of hands to recommend that lawmakers impose the new charge, a step that's opposed by AARP, the seniors' lobby.
The advice comes as lawmakers face a tough budget year. A sluggish economy and tax cuts are draining revenue while deficits soar to ranges widely seen as unsustainable. Republicans won control of the House on a promise to curb spending, yet there's little hope of that unless Congress and the president can agree on ways to restrain health care costs.
More than 3 million seniors and disabled people on Medicare use home health services — visits from nurses, personal care attendants and therapists, available to those who can't easily get out of the house.
Home health was once seen as a cost saver, since it's clearly cheaper than admitting patients to the hospital. But it's been flagged as a budget problem because of rapidly increasing costs and big differences in how communities around the country use the benefit.
Numerous studies have shown that even modest copayments can discourage patients from getting medical services. The new charge would be collected for each home health agency admission, not for every visit by a nurse or provider. Patients can be under home health care for weeks at a time.
The recommendation exempts low-income patients, as well as those just discharged from the hospital. The new fee would be levied on the more than 30 million beneficiaries in traditional Medicare, although it could have repercussions for seniors in private Medicare Advantage plans as well.
The commission was created by Congress to provide unbiased expert advice on complicated issues of Medicare benefits and financing. It's also known as MedPAC.
