This study uses new Medicare Advantage (MA) encounter data from the Centers for Medicare & Medicaid Services (CMS) combined with Medicare Fee-for-Service (FFS) data and publicly available data on home health agencies. This study examines differences in home health care use, including services within home health episodes and receipt of care from high-quality home health agencies, comparing beneficiaries enrolled in MA versus FFS by rural-urban status and geographic region. Analyses also examine intra-rural variation and differences by MA plan type. Results have important policy implications as MA enrollment grows and MA plans explore greater flexibility in offering home-based services than the FFS program. In addition, incentives for serving rural FFS beneficiaries will decrease and sunset in three years, and a new FFS home health payment system started in CY2020.

Understanding baseline differences in home health care between MA and FFS beneficiaries across the rural-urban continuum will help inform future policy initiatives for both programs from the perspective of rural beneficiaries and providers, a key component of CMS's rural health strategy.