Designing a supplemental transportation benefit for Medicare Advantage Members

Joe Corcoran
Joe Corcoran
medicare-advantage-plans

Every Medicare Advantage plan is thinking about how the social determinants of health fit into their supplemental benefit strategy, and in particular, the national market is focusing on transportation. This past October, we learned that in 2020, 33% of the 3,148 Medicare Advantage plans are going to offer some type of transportation benefit to their members compared to 22% in 2019 (Kaiser Family Foundation). That’s serious growth, and for 2021, there are no signs of transportation benefits slowing down. The question is, why are so many MA plans offering transportation as a benefit? Is it just a sales tactic to increase their enrollments for 2020, or does this benefit actually have an impact on their members’ health?

At a high level, we know that 3.6 million appointments are missed or delayed every single year due to transportation barriers. For the senior population, transportation is considered a top-three barrier to care. In painting the United States with a broad brush, it’s safe to say that the country has a healthcare transportation problem with seniors. CMS sees this too. For the Medicaid population, CMS understood the transportation barrier, implemented unlimited rides for members, and saw a positive impact. Now, they are adding more flexibility to Medicare Advantage plans on their supplemental benefits concerning social determinants of health.

As people age, transportation becomes more of a barrier to access the care they need as well as the access to live healthier and more fulfilled lives. But what about you and your plan? What about your community? Is transportation a barrier in your market? If it is, how can you design a transportation benefit with your specific member needs in mind? This is the fun part. Let’s review some live examples.

Oscar Health says they want to reduce readmissions, so they implemented a transportation benefit in 2020 that provides rides to follow up appointments for three weeks post-discharge. GlobalHealth identified a transportation barrier years ago, but the need only applies to some of their members rather than all. Their benefit includes 5-6 round trip rides per year to eligible members with certain chronic conditions like COPD or diabetes. When a Kaiser Permanente MA Plan offers a transportation benefit, they’ll commonly cover up to 24 one-way rides per calendar year to all members to and from a network provider. Although designed differently, each plan has identified transportation as a barrier for members thus have included a benefit to increase access, prove healthier outcomes, and reduce the cost of care. 

As you decide how transportation fits within your supplemental benefit strategy, think about your members first. Are you seeing a lot of members being discharged but then missing their follow up appointments leading to readmission? A benefit similar to Oscar’s post-discharge benefit may be right for you. Have you identified a specific group with higher needs/costs? i.e., kidney disease members who are struggling to make their dialysis appointments every week. If so, designing eligibility around certain chronic conditions may be the best style fit for your members. Or maybe you’re like the rest of the United States, where transportation is a significant barrier for all of your members. Twenty-four one-way rides a year could be an easy fix to making a real impact.

As you begin to explore a transportation benefit for your members, keep in mind that 92% of MA beneficiaries have access to a plan that includes a transportation benefit (Kaiser Family Foundation). Transportation barriers may be new for you, but they’re not new for your members. Your members deserve your due diligence and research on all the options for the supplemental benefit strategy.