Part 2: Local Transportation as a Medicare Advantage Benefit
In February, The Centers for Medicare and Medicaid Services (CMS) announced that it was increasing “flexibility in Medicare Advantage that will allow more options and new benefits to Medicare beneficiaries, meeting their unique health needs and improving their quality of life.”
Starting in 2019, under this new policy, CMS will “allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”
By expanding the definition for supplemental benefits, CMS opens the door for MA plans to address social determinants of health more directly. One such social determinant is transportation. Roundtrip can help improve the quality of more patients’ lives, specifically those with MA plans. We can offer more reliable, cost-effective medical transportation for any type of transport needed. Other examples of redefined, health-related supplemental benefits that increase health and improve quality of life include:
- non-skilled in-home supports
- portable wheelchair ramps
- and other assistive devices and modifications when patients need them.
CMS Administrator Seema Verma expressed, “Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans.” She continued, “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.” We are really excited that they are declaring a strong focus on patients and improving quality of life — because we are right there with them.
CMS has previously not allowed an item or service to be eligible as a supplemental benefit if the primary purpose included daily maintenance. Under the new policy announced today, CMS would allow additional benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.
According to the AHA, 3.6 million people in the U.S. do not obtain medical care due to transportation barriers, and transportation is the third most commonly cited barrier to accessing health services for older adults. Currently, ~35% of Medicare beneficiaries (20 million Americans) are enrolled in MA plans, and enrollment is projected to rise to 38 million or 50% market penetration by the end of 2025.
Expanding supplemental benefits to transportation will allow us to assist more seniors in getting to appointments, expand pharmacy access and increase necessary prescription fills, and reduce the overall economic burden for patients and the health care system.