Benefits of NEMT billing software

How the Transportation Benefit in Medicare Advantage is Growing

Transportation is one of the primary social determinants of health and has become a more prominent issue in the past decade. While emergency transportation has always been an included part of most insurance policies, this is not the case with non-emergency medical transportation (NEMT). Luckily, this reputation is changing for the better, as explicitly seen through Medicare Advantage’s updated benefit plans and the services offered within them.

How has the Need for Medicare Increased?
Medicare has seen significant growth in the United States’ total annual spending, as well as member enrollment in the past several years. From 2015 to 2019, Medicare has reported an 8.6% increase from 55.9 million to 60.7 million enrollments. In 2021, Medicare accumulated $829 billion in benefit payments in comparison to $541 billion in 2011. According to the U.S. Congressional Budget Office, this upward trend is expected to continue through to 2031.

What is Medicare Advantage?
Medicare Part C, otherwise known as Medicare Advantage (MA), is an insurance plan available to older adults over 65 and younger people with disabilities already enrolled with Medicare’s Part Aand B plans. Many receiving Medicare benefits opt to purchase a gap policy to cover those medical services not included in Medicare’s Part A and B. For others, purchasing a Part C (MA) plan makes sense. MA plans are offered through private insurance companies. Companies combine existing Medicare benefits with additional services (at times for an additional cost). Individuals with MA planshave access to all their insurance coverage in one, convenient place.

Medicare Advantage has experienced tremendous growth, which is largely due to the steady increase in the aging population in the United States. As more baby boomers become eligible for Medicare, Medicare Advantage is seeing an increase in private plan enrollment. This growth is so significant that Medicare has invested more into private Medicare Advantage plans for enrollees than the total costs for Original Medicare. While Medicare Advantage offers multiple plans that provide benefits for enrollees all in one place, which made utilizing coverage seamlessly, private insurance has sought to elevate MA with the addition of unique benefits not found in Original Medicare plans.

Beginning in 2020, Medicare Advantage plans began to include extra items or services that are non-primarily health-related for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). These benefits are offered if they are believed to have a reasonable expectation of improving or maintaining the overall function and health of the chronically ill individual. Government studies indicate that MA plans may use the social determinants of health to assist in the identification of enrollees, as well as further SSBCI eligibility. One of the services being offered is NEMT transportation services to acquire non-medical items, such as grocery shopping, banking, and transportation.. Medicare Advantage plans to display an increasingly widespread use of non-emergent medical transportation, through company-contracted transportation services, as well as vouchers for public transportation and transportation companies, such as Uber and Lyft. Utilizing software, such as NovusMED, would provide additional support for MA to ensure transportation services being offered are efficiently organized and implemented.

Why are NEMT services so important?
The American Journal of Public Health published a study that concluded nearly 5.8 million Americans miss or delay their healthcare due to a lack of transportation each year. There are many factors that contribute to this lack of transportation, such as financial insufficiencies, lack of public transit, or the inability to drive. More than 20% of older adults, and many more with chronic diseases, are not able to drive, which reinforces the importance of transportation services, especially NEMT.

From a long-term perspective, Medicare Advantage faces financial pressures associated with higher health costs, growing enrollment, and an aging population. These pressures heighten the importance of each service used by enrollees. Given the inclusion of NEMT services within MA plans and SSBCI, private insurance will experience an increase in demand for transportation services, as well as a way to manage them. The standard that Medicare Advantage has established for itself in the past is of a high quality, and the transition to include more benefits will need to be prepared to maintain this standard.

If there are any questions related to the newly included NEMT benefits, visit Momentm’s website to learn more.

Kris Lyon

Kris, VP, Business Development, specializes in adapting the operational needs of customers to Momentm's NEMT software platforms. With a strong 30+ year history working in the Health and Human Services field, Kris provides insight into the health care industry and its relation to medical transportation.

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