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MedicareAdvantageChangesandCommunityTransportationMay2018

InearlyApril,theCentersforMedicareandMedicaidServices(CMS)announcedare-interpretationofthestandardsforhealth-relatedsupplementalbenefitsthatpavesthewayforprovidingmoretransportationinMedicareAdvantagehealthplans.ThiscouldofferabigopportunityforCTAAmembersandothercommunitytransportationproviders.WithintheMedicareAdvantagehealthinsuranceprogram,insurerswillbeabletoofferitemsandservicesthathavenotbeenincludedintraditionalbenefitplansandmaynotdirectlybeconsideredmedicaltreatment,butwilldirectlyimproveoverallwellnessandqualityoflife.UnlikeMedicaid,traditionalMedicaredoesnotofferanon-emergencymedicaltransportationbenefit,buttherecentCMSannouncementmayleadtosomeMedicareAdvantageplansofferingtransportationbenefitsunderthisdefinition.TolearnmoreaboutthedifferencesbetweenMedicareandMedicaidpleaseseethetableincludedonpage3ofthisdocument. AllMedicareparticipantsbegintheircoveragewithtraditionalMedicare(PartA:HospitalandPartB:Medical).WhilesomeindividualsdecidetostaywithtraditionalMedicare,somemaychoosetojoinMedicareAdvantage.MedicareAdvantageplansmayprovideadditionalhealthcarecoverageandbenefits,butenrollmentintheseplanscarriesanadditionalcost,andisnotavailabletoindividualswhoreceivefinancialassistanceinthetraditionalprogram.However,forthosewhohavethefinancialabilitytoenroll,theyareabletoreceiveincreasedcoverageandadditionalbenefitssuchasvision,dental,andemergencyresponsesystems.Forperspective,lastyearoutof61millionMedicareenrollees,20millionindividualsenrolledintheMedicareAdvantagecoverageoption.WhiletheseplansalreadyoffersomehealthbenefitsnotcoveredbytraditionalMedicare,thenewrulewillallowevenfurtherexpansiontoitemsandservicesthatmaynotbedirectlyconsideredmedicaltreatment.Inanannouncementpresentingapolicythatlowersdrugcosts,CMSnearlyburiesthissignificantpolicystatement,whichreinterpretsthestandardsforhealthrelatedsupplementalbenefitsintheMedicareAdvantageprogram.AccordingtoCMS,whatisconsidereda“primarilyhealthrelated”

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benefitwillbeexpandedtoallowadditionalsupplementalbenefitsifthey“compensateforphysicalimpairments,diminishtheimpactofinjuriesorhealthconditions,and/orreduceavoidableemergencyroomutilization.”WhatgoesunsaidintheannouncementisthatCMShascrackedopenthedoortomoreopportunitiestoprovidenon-emergencymedicaltransportationforMedicareAdvantageenrollees.ThegoaloftherulechangeistoallowMedicareAdvantagebeneficiariestheopportunitytoreceivemoresupplementalbenefits,makingiteasierforthemtoleadhealthier,moreindependentlives.Giventhedifferencesamonginsurersacrossthecountry,itislikelythatthebenefitsaddedasapartofthisrulewillvarybyinsurer,andthereforenotbeconsistentacrossplansorenrollees.Untilfurtherguidanceisreleased,insuranceplansbegindesigningbenefits,andenrolleesbeginusingthem,itremainsuncertainbothhowthesebenefitswillworkinpractice,orhowtheywillactuallyimpactbeneficiaries’health.FurtherguidancewillhopefullybereleasedbyCMSinthenearfuture.Itisalsoimportanttonote,whiletransitmaybereadytojumprightintoprovidingservices,noneofthiswillbereadyforactionuntilafterthe2019MedicareAdvantageplansaresubmittedtoandapprovedbyCMS.Therefore,transitproviderswillneedtowaitandseewhatchangesinsuranceplansmaketoavailablebenefitsbeforejumpingintoprovidingandbeingpaidforservicestoMedicareAdvantageenrollees.Despitetheremainingquestionsaroundthechange,industryexecutivesfrombothhealthcareandtransportationhavenotwastedanytimeinhighlightingthepotentialopportunitiesthatthisnewrulecouldoffer.Generally,theyagreethatthischangesetsthestagetocontinuetoinnovateandprovidechoicesforMedicareenrollees.Transportation,inparticular,ispoisedtogreatlybenefitfromthischange,asentitieswillbeabletooffertransportationsolutionsthatcatertoMedicareAdvantagemembersthatcontributetobetteroverallheath.Giventherecentfocusontheintersectionbetweentransportationandhealthcare,andthepublicityofUberandLyft’snewhealthrelatedendeavors,theCMSannouncementcomesatatimeofgreatopportunityfortransittofindaroleforitselfwithinhealthinsuranceplans.ThebenefitstotransportationproviderswilldependonthenumberofMedicareAdvantageinsurerswhodecidetoincludetransportationasabenefitwithinthenewrules,aswellaswhotheydecidetopartnerwithtoprovidethattransportation.Non-emergencymedicaltransportationbrokersandprovidersmayfindthemselvesagoodfitforthesetripsgiventheirexpertiseworkingwithhealthinsuranceprovidersandthehealthcaresystem.However,publictransitproviders,transportation

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networkcompanies,andtechnologycompanieswillallbeapartoftheconversationandshouldnotbecountedoutofthemix.CMS’sannouncement,whiletargetingMedicareAdvantageinsurancecoverage,couldtrulybeaturningpointforhealthcaretransportation.ThechancetoaddresssocialdeterminantsofhealthwithinMedicareAdvantagebenefitswillallowtransportationproviderstheopportunitytopartnerevenmoredynamicallywithMedicare.Serviceswillnotonlybeabletohelpseniorsgettotheirhealthappointments,butbeabletomorebroadlyleverageservices,removetransportationbarriers,andencouragehealthyandactiveliving.

Medicare Medicaid

What:

Afederalhealthinsuranceprogramforpeoplewhoare:

• 65orolder• Under65withcertaindisabilities• OfanyageandhaveEndStageRenal

Disease(ESRD)orALS

Afederalandstatehealthinsuranceprogramthatprovidescoverageforcertainindividualsandfamilieswithlimitedincome.Medicaidencompassesanumberofprogramsthatarealldesignedtohelpspecificpopulations.

Governedby: FederalGovernment StateGovernments

Coverage:

Dependentontheindividual’sselectedcoverage.Itcaninclude:

• Hospitalcare:PartA• Medicalcare:PartB• Prescriptiondrugs:PartD

Note:MedicareAdvantageplans(PartC)combinePartAandPartBcoverage,andoftenincludedrugcoverage(PartD)aswell-allinoneplan.

Dependentoneachstate’sownMedicaidprogram,whicharecreatedfollowingfederalguidelinesandincludebothmandatoryandoptionalbenefits.

Cost:Dependsonselectedcoverage,andcanincludepremiums,deductibles,copaysandcoinsurance.

Dependsonincome,andstateprogramstructure.Costscanincludepremiums,deductibles,copaysandcoinsurance.

Eligibility:Mostpeopleareautomaticallyenrolledwhentheyturn65inMedicarePartsAandB.

Eligibilitydependsontherulesinyourstate,andismostoftenbasedonincome.

Informationadaptedfrom:MedicareMadeClear,byUnitedHealthcare