New rules allowing health insurers to include more supplemental benefits in their Medicare Advantage plans may open the door to millions of ride-sharing trips via Uber or Lyft to the doctor’s office, clinic or pharmacy for millions of elderly Americans.
Health insurers are talking about the possible benefits ride-sharing companies will bring to seniors after the Centers for Medicare & Medicaid Services (CMS) last week said it was “reinterpreting the standards for health-related supplemental benefits in the Medicare Advantage program to include additional services that increase health and improve quality of life.”
CMS is also broadening its definition of “primary health related” in the Medicare Advantage program. “Under the new definition, the agency 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,” CMS said.
“This new flexibility will allow Medicare Advantage plans to broaden the scope of services tailored to assist patients,” Blue Cross Blue Shield Association’s Kris Haltmeyer said, adding that such services could include “transportation to medical appointments.”
The market is fast-growing with more than 10,000 Americans turning 65 and becoming eligible for Medicare, and more of them are choosing privately run Medicare Advantage plans. Currently, just under 35% of Medicare beneficiaries, or about 20 million Americans, are enrolled in MA plans but L.E.K Consulting last year projected Medicare Advantage enrollment to rise to 38 million or 50% market penetration by the end of 2025.
Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines, with some even providing vision and dental care and wellness programs.
But the ability of Medicare Advantage plans to integrate ride-sharing services into bids could be a boon to Uber and Lyft at a time they are already finding success working with health insurers. Blue Cross plans, for example, have been working with ride-sharing companies to offer ride-sharing as part of commercial benefit packages.
Blue Cross and Blue Shield plans last month expanded a partnership with the ride-hailing company Lyft to provide a way for enrollees who don’t have adequate transportation to get to their neighborhood Walgreens Boots Alliance and CVS Health pharmacies, building on an effort the Blue Cross Blue Shield Association announced last year with Lyft to provide “no-cost” transportation to the doctor’s office in an effort to improve compliance with healthcare appointments.
The new Medicare Advantage guidance is another opportunity for ride-hailing companies.
“This guidance demonstrates how serious CMS is in giving health plans the tools they need to address the social determinants of health – of which transportation is foundational,” Lyft director of federal government relations Lauren Belive said. “This new flexibility will allow us to partner even more dynamically with MA plans, to not just help seniors suffering from chronic health conditions get to their health appointments, but to more broadly leverage our platform to remove transportation barriers, and encourage healthy and active living.”
Health insurers in the Medicare Advantage business have to submit their annual bids to the government by June 4, letting CMS know what health benefits their plans will offer for 2019. Any additional services that plans want to offer would still have to be approved by CMS.
If ride-sharing becomes part of a Medicare Advantage plan’s package, companies are hopeful they can help reduce costs and improve outcomes for seniors who don’t have adequate access to transportation. As health insurers move away from fee-for-service medicine to value-based care and population health models that make sure patients are getting quality care in the right place and at the right time, ride-sharing companies say they can have a key role.
“We are dedicated to improving the lives of seniors with the world’s best transportation – whether providing rides to bring elderly passengers to and from health appointments, or providing transit solutions that enable increased independence and reduced isolation,” Lyft’s Belive said.