medicare advantage changes and community transportation · medicare advantage changes and community...
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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