Medicare Advantage Home Visits: Limits Proposed
- Two major players in the health insurance arena, UnitedHealth Group (UNH) and Humana (HUM), are actively pushing for greater scrutiny and restrictions on payments to insurers regarding in-home...
- UnitedHealth has specifically called for enhanced MA oversight of in-home clinical visits,proposing annual audits focused on these assessments.
- "UnitedHealth Group has long advocated for thoughtful, forward-looking solutions to modernize and strengthen Medicare Advantage, especially in the areas around accountability, transparency and clinical value," the company stated.
UnitedHealth and Humana are pushing for increased oversight and payment limits on Medicare Advantage in-home clinical assessments. News from News Directory 3 reveals the insurance giants seek greater scrutiny of this lucrative sector, advocating for annual audits and restricted payments tied to diagnoses made during these visits. Humana supports limiting payments for diagnoses solely recorded during insurer-initiated home visits, sparking debate over billions of dollars in potential changes. This push comes as UnitedHealth faces scrutiny over its Medicare Advantage billing practices. The Better Medicare Alliance warns that cutting MA could harm millions of seniors who rely on these services. Discover what’s next for Medicare Advantage recipients and the impact these proposed changes might have on their care.
UnitedHealth, Humana Advocate for Medicare Advantage Oversight, payment Limits
Updated June 7, 2025
Two major players in the health insurance arena, UnitedHealth Group (UNH) and Humana (HUM), are actively pushing for greater scrutiny and restrictions on payments to insurers regarding in-home clinical assessments within Medicare Advantage (MA) plans. This move aims to address concerns about accountability and transparency in the lucrative MA sector.
UnitedHealth has specifically called for enhanced MA oversight of in-home clinical visits,proposing annual audits focused on these assessments. Humana has voiced support for limiting payments tied to diagnoses made by nurse practitioners during home visits. The company also suggests that diagnoses solely recorded during insurer-initiated home visits should not trigger additional payments. The Wall Street Journal reports these payments amount to billions of dollars.
“UnitedHealth Group has long advocated for thoughtful, forward-looking solutions to modernize and strengthen Medicare Advantage, especially in the areas around accountability, transparency and clinical value,” the company stated. “UHG supports policies that hold in-home clinical visits to the highest standard and are supportive of a wide range of solutions that modernize in-home clinical assessments.”
To that end, UnitedHealth supports policies that ensure beneficiaries with new diagnoses from in-home visits receive timely follow-up care, require health plans to connect beneficiaries to care coordination programs, standardize in-home assessments to CMS best practices, increase program oversight via enhanced reporting, and institute annual audits.
Notably, UnitedHealth, which recently reaffirmed its commitment to more frequent MA plan audits, is reportedly under investigation regarding its Medicare Advantage billing practices. The company maintains it “stands firmly” behind the integrity of its MA program.
According to KFF, UnitedHealth and Humana together account for 47% of all MA enrollees nationwide.
the Better medicare Alliance, an advocacy group, cautioned that cutting Medicare Advantage, especially in-home care, would harm older adults.
Mary Beth Donahue, president and CEO of Better Medicare Alliance, said that cutting Medicare Advantage, and particularly in-home care, would break a promise to millions of seniors who rely on it.
What’s next
The debate surrounding Medicare Advantage oversight and payment structures is expected to continue, with potential implications for both insurers and beneficiaries. Increased scrutiny could lead to changes in how in-home assessments are conducted and reimbursed, impacting access to care and the financial stability of MA plans.