The largest home health operators, and who's behind them

The two largest home health operators in the country are owned by health insurers. Humana runs the biggest, UnitedHealth the second. That single fact explains more about where home health is heading than any margin in the sector, and it makes the operator question different from the one you would ask about skilled nursing or hospice.

• Largest operator — 3.6% · CenterWell, 208 agencies in-file
• Top ten share — 11.3% · Tighter at the top than hospice
• Distinct operators — 603 · About three quarters run one location
• Optum labels — 182 · Amedisys, LHC, and UnitedHealth Group combined

How consolidated home health is

Home health is fragmented at the bottom and concentrating at the top. The cost-report file identifies 603 distinct operators across roughly 5,800 agencies, and about three quarters of them run a single location. A long tail of independents still holds most of the market. But the top is tighter than hospice: the largest operator runs about 3.6% of agencies, against 1.5% for the largest hospice operator, and the biggest names are national platforms rather than regional roll-ups.

The largest ten operators hold 11.3% of agencies. What makes home health distinct is not the concentration level, which is still modest, but who occupies the top of the list. In hospice, the serial buyers are private-equity platforms. In home health, the two largest are payers, and that changes the logic of every deal below them.

The largest operators by footprint

By agencies present in the dataset, the largest operators are CenterWell (208), Amedisys (158), Enhabit (126), and Elara Caring (51). Below them, a cluster of regional and mid-market operators fills out the top of the table, including Angels Care, The Pennant Group, and Excelin Health.

Read these as an in-dataset ranking, not a national tally, and read them with one caution the file makes plain. Commonly owned entities are listed under separate operator names. Amedisys, LHC Group, and a UnitedHealth Group label all appear as distinct lines here, even though all three now sit under UnitedHealth's Optum. Add them up and Optum's true home health footprint is far larger than any single label suggests. The in-file view is the right frame for a comparable count, but the real ownership map requires rolling these labels up to the parent.

Who's behind them: payers, strategics, and private equity

The ownership story is the story. CenterWell is Humana's home health business, built out of its acquisition of Kindred at Home. Amedisys and LHC Group both belong to UnitedHealth's Optum, the Amedisys deal closing only after a Department of Justice challenge. Two of the three largest home health platforms in the country are owned by the two largest Medicare Advantage insurers, which is not a coincidence.

A payer that owns the home health agency controls the lowest-cost site of care and can direct its own members into it, capturing the margin and the medical-cost savings at once.

That is vertical integration, and it is the defining move in the sector.

Enhabit, the independent public company in the top group, is the exception that shows the shift. After a strategic review, it agreed to go private to the private-equity firm Kinderhook Industries for about $1.1 billion. Elara Caring, the fourth-largest, is likewise a private-equity-backed platform. The pattern, after years of payer-led mega-deals, is that private equity is reasserting on the largest transactions while the payers digest what they have bought and antitrust scrutiny raises the bar on further insurer acquisitions.

Sizing private equity across the rest of the sector is not possible from public data. The cost-report ownership flag captures identified sponsors only, and many PE-owned agencies close under holding-company or acquisition-entity names rather than a recognizable operator, so the flag undercounts. The honest read is by named platform and sponsor, not a penetration rate. What the data does show clearly is the mid-market machine:

What buyers value

Home health buyers are not paying for the standalone margin, which the sector's economics make clear is thin and volatile. They are paying for three things.

• Site of care — A position at the lowest-cost site of care, which is why a risk-bearing payer values an agency far above its own income statement.
• Scale and density — A denser route lowers the cost per visit and improves the visit-mix economics that drive agency margin.
• A clean record — Compliance and quality history is scarce enough that buyers compete for the agencies that have it.

That is why the priced deals split so widely. A payer or strategic buying national scale pays up, as UnitedHealth did for Amedisys at roughly 15 times EBITDA, while a regional agency without a strategic angle changes hands closer to the sector's typical mid-single-digit multiple. The buyer's identity, not just the agency's numbers, sets the price.

For anyone researching an operator, the practical steps are the same as the rest of post-acute, with the payer overlay on top.

• Roll labels up — Roll the in-file operator labels up to their parent, because the largest owners hide behind multiple names.
• Identify the owner type — Check whether the owner is a payer, a strategic, or a sponsor, because that determines both the buyer universe for a future sale and how the agency is likely run today.
• Separate footprint from control — A national brand and a locally owned agency operating under it are different risks.

To place a specific agency or operator against the sector, the Post-Acute tool rolls agencies up to operators and sponsors and returns footprint, revenue, and margin on the free tier. For where these operators sit financially, see what home health agencies earn; for the metric that drives agency economics, see home health revenue per visit.

Sources and method

• Source — CMS HCRIS provider cost reports, FY2024 and FY2025 filings
• Footprint set — 5,775 home health agency rows, excluding consolidated filings; 603 distinct operators
• Common ownership — Operator labels are not rolled up to parents in the file: Amedisys, LHC Group, and a UnitedHealth Group label all appear separately though all are Optum-owned, and summing them raises Optum's true footprint to 182 agencies in-file
• Private equity — The ownership flag captures identified sponsors only and undercounts; PE is reported by named platform and sponsor rather than as a sector-wide rate
• Deal data — Scope Research Volume and Valuation Databases; acquirer counts cover 2019-2026
• Ownership status — Per company disclosures and trade reporting; confirm current status at publish
• Known limits — Self-reported, unaudited, and lagging current operations by 12 to 24 months

Full methodology and limitations

Disclaimer

This article is a market-data benchmarking resource derived from publicly available Medicare cost reports and third-party M&A data. It does not provide, and must not be relied upon as, a fair market value determination, valuation opinion, appraisal, or legal, tax, or compliance advice. Cost-report figures are self-reported, unaudited, and subject to revision. The opinion of value for any specific arrangement remains the professional judgment of a qualified appraiser.