Recent data releases from the Centers for Medicare & Medicaid Services (CMS) provide an important snapshot of how Medicare enrollment, utilization, and spending patterns are evolving nationally and in Florida. Taken together, these datasets underscore the growing demand for home-based care, the increasing clinical complexity of Medicare beneficiaries, and the mounting financial pressures facing home health agencies that serve this population.

Medicare Beneficiaries: Growing, Aging, and Increasingly Complex

In 2023, Medicare covered 66.5 million Americans, including 3.9 million new enrollees. While most beneficiaries qualify based on age, a substantial share qualifies due to disability or advanced age:

• 11% are under age 65 due to disability
• 10% are age 85 or older
• 19% are dually enrolled in Medicare and Medicaid

Chronic conditions are widespread across the Medicare population:

• 65% have high blood pressure and high cholesterol
• 36% have arthritis
• 26% have diabetes
• 19% have chronic kidney disease

Although 95% of beneficiaries report satisfaction with their care, access challenges persist. Only 41% report being able to obtain a doctor’s appointment within one week — reinforcing the role of home-based services in maintaining access and continuity of care.

Florida’s Medicare Landscape: A Rapid Shift Toward Medicare Advantage

Florida mirrors national enrollment growth but stands out for the speed and scale of its transition away from traditional Medicare fee-for-service (FFS) toward Medicare Advantage (MA). As of 2025, Florida has 5.2 million Medicare beneficiaries, with 57% enrolled in MA and just 43% remaining in FFS — a sharper imbalance than the national split, where MA accounts for approximately 51% of enrollment.

This shift has accelerated steadily over the past decade. In 2013, nearly 72% of Florida beneficiaries were enrolled in FFS Medicare. By 2024, that figure had fallen below 50%, and by 2025, MA enrollment surpassed FFS statewide.

MA penetration is also highly uneven across Florida. Counties such as Miami-Dade (76%), Gadsden (72%), and Osceola (71%) have some of the highest MA enrollment rates in the state, while counties like Monroe (24%) and Okaloosa (35%) remain predominantly FFS. This geographic concentration amplifies the operational and financial pressures faced by home health agencies in high-MA markets, where utilization management, prior authorization, and payment practices are largely dictated by managed care plans rather than Medicare’s standardized FFS rules.

Utilization Patterns Highlight the Central Role of Home Health Care

Medicare utilization data show that while inpatient hospital stays (13%) and emergency department visits (24%) affect a minority of beneficiaries annually, post-acute and in-home services remain a critical component of care transitions. Approximately 9% of beneficiaries receive post-acute care services each year, underscoring the role of home health agencies in preventing readmissions and supporting recovery at home.

Florida’s 2023 Medicare Home Health Agency Cost Report data illustrate the scale of this activity. During the cost reporting period, Florida’s 1,019 Medicare-certified home health agencies delivered more than 7 million Medicare home health visits — an average of over 10,000 visits per agency.

Visits by discipline included:

• 2.5 million registered nurse visits
• 1.6 million physical therapy visits
• 1.0 million licensed practical nurse visits
• 216,000+ home health aide visits

These data reflect a clinically intensive, home-based model serving beneficiaries with multiple chronic conditions and functional limitations.

Costs, Charges, and the Reality of Providing Care

The cost report data also provide insight into the financial realities of delivering home health services. Total statewide costs exceeded $2 billion, with registered nurse services representing a significant share of aggregate spending ($705 million). Average per-visit costs varied by discipline, reflecting differences in training, scope of practice, and time intensity. Importantly, these figures represent costs incurred by providers, not margins, and do not account for payment reductions, denied claims, or administrative expenses associated with managed care oversight.

• Registered Nurse: $239 per visit
• Physical Therapy: $247 per visit
• Home Health Aide: $371 per visit

These figures represent provider costs, not margins, and do not account for denied claims, delayed payments, or administrative burdens associated with managed care oversight. Payment mechanisms such as Low Utilization Payment Adjustments (LUPAs), Partial Episode Payments (PEPs), and outlier thresholds further introduce financial volatility — particularly for agencies serving high-acuity patients.

Telehealth Use: Stable But Uneven

Telehealth utilization among Medicare beneficiaries in Florida stabilized in 2024 at roughly one-quarter of Part B enrollees on an annual basis, with quarterly utilization rates closer to 12-13%. Data from the first quarter of 2025 show a modest increase in utilization despite a slight decline in overall enrollment, suggesting sustained demand for virtual care options.

Notably, telehealth use is highest among beneficiaries with disabilities and those under age 65, indicating its importance for individuals with ongoing, complex care needs. A persistent urban-rural gap remains, with rural beneficiaries using telehealth at lower rates than their urban counterparts, raising concerns about broadband access and digital equity.

Policy Implications for Florida and Beyond

Collectively, these data points tell a consistent story. Medicare beneficiaries are older, sicker, and increasingly reliant on care delivered outside traditional institutional settings. At the same time, home health agencies are operating in an environment of declining FFS enrollment, expanding managed care oversight, and rising workforce and compliance costs.

For policymakers, these trends underscore the need to ensure payment adequacy, preserve beneficiary access to home-based services, and recognize home health care as an essential component of the health care system rather than a discretionary add-on. For Florida, where MA penetration is among the highest in the nation, these considerations are especially urgent.

As Medicare continues to evolve, the data make clear that sustaining a strong, stable home health infrastructure will be critical to meeting beneficiary needs, controlling overall health care spending, and supporting aging in place for millions of Floridians.