Blog Post

Medicare Changing Guidelines: Reduce Healthcare Costs and Emergency Room Visits with Non-Medical Supplemental Benefits
by Catherine Mandler


The Centers for Medicare & Medicaid Services (CMS) issued the “Announcement of Calendar Year (CY) 2019  Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter” which highlights the expansion of the Supplemental Benefits Standard. CMS moved forward with expanding the scope of the current supplemental benefit standard, opening the door for far more “daily maintenance” services that reduce illness, injury, and unnecessary emergency room (ER) utilization. This allows more supplemental benefits to be included in product design

SMIS Dual Report Cover Final 2What Does This Mean For You? Opportunity to Improve Doctor Accessibility with Expanded Supplemental Benefits

According to SCI Solutions, “Missed appointments cost Healthcare Providers $150 billion/yr., with no-show rates as high as 30%.”

Let’s take a look at one possible scenario. Assume a health plan member is currently enrolled in Medicare, under 65, due to a health condition that prevents him from working and leaves him with limited income. He needs to visit his doctor twice a month to receive medical evaluation. Since his doctor’s office is across town, he requests a “taxi voucher” from his doctor to help cover the transportation cost.

“We’re prepaying taxi vouchers on the premise that a Yellow Cab is a lot less expensive than an ambulance,” says James Langabeer, professor of clinical informatics at UT, Non-Emergency transportation benefit. According to, "In many cities, an individual over 18 years old who has a disability and adults over 55 years old are eligible for a taxi voucher program, depending on their income."

Non-Emergency Transportation Reduces Health Plan Costs While Improving Positive Health Outcomes

One study in the Journal of Immigrant and Minority Health found that lack of a ride caused “25% of suburbanites in the survey to miss at least one medical appointment.” Some patients simply call 911 when they need primary care. According to, app-based rideshare services such as Uber and Lyft are already shaking up  non-emergency medical transportation. Lyft began its healthcare work in 2016 with a pilot in a nonemergency medical transportation company National Medtrans Network in New York City. Lyft reported a 28% increase in patient satisfaction among participants in the pilot, mostly senior citizens. Learn more about who non-emergency transportation benefits would appeal to in our Dual Eligible Member Study.  

Personalizing Supplemental Benefits for Your Members

Adding a Transportation benefit, such as an app-sharing ride, to your product design for a Medicare eligible individual who is low income, or Dual Eligible, is an opportunity to improve health outcomes. Improve health outcomes by improving provider accessibility, member experience, and differentiate yourself from the competition. A Transportation benefit decreases health plan costs since more patients can receive the medical attention needed on a regular basis and have an alternative to emergency vehicle transportation and sub-optimal taxi vouchers. Members are also able to make their doctor appointments in less time and with less effort. Quality scores improve by providing real value to members. 

Deft Research’s study provides an analysis of Dual Eligible shopping and switching activities, consumer experiences with their plans, and other opportunities to serve this market.

Download our 2018 Dual Eligible Study Infographic  for more insights. 

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