Part 1: Transportation as a Social Determinant of Health (SDOH): How Medicare Advantage Plans Are Responding

As we inch closer to the 2025 Medicare Advantage (MA) Open Enrollment period, one benefit that’s garnering attention is non-medical transportation. For older adults and individuals with mobility challenges, having access to safe and reliable transportation can be the difference between isolation and independence.

In this exploration, I took a closer look at how county-level COVID-19 Community Vulnerability Index (CCVI) scores—often used as a proxy for social determinants of health—correlate with MA Part C plans offering non-medical transportation. Here’s what I found.

Why Transportation Matters for Seniors

1. Enhanced IndependenceSeniors who can’t drive or lack access to public transportation risk missing medical appointments, community events, or even everyday errands.

2. Reduced Social IsolationIsolation is a serious health risk. Access to transportation allows older adults to stay connected with friends, family, and their broader community.

3. Physical FitnessBeing able to travel to gyms, fitness centers, or community exercise classes supports better health and wellness.

4. Access to Quality FoodNutritious food is vital for overall health, and transportation ensures seniors can reach grocery stores that carry fresh produce and other healthy options.

Using CCVI as a Marker for Need

The COVID-19 Community Vulnerability Index (CCVI) offers a snapshot of a county’s resilience—or lack thereof—to health crises. High CCVI scores often indicate a community with:

• Greater social and economic challenges

• Limited healthcare resources

• High levels of chronic disease

By comparing CCVI quintiles (from Very Low to Very High) with Medicare Part C plan data, I hoped to see whether non-medical transportation benefits align with the communities that need them most.

Understanding the Legend

In the data visualizations, different colors represented the status of non-medical transportation in plan offerings:

• Blue (1): The plan explicitly offers non-medical transportation in the benefits data.

• Yellow (3): The plan benefit exists in the data but is listed as null—a possible indicator of incomplete or unclear information.

• Green (4): The plan appears in enrollment data but not in the Part C benefits data, which may suggest a reporting gap or missing documentation.

Three Key Observations

1. Increasing Count of Benefits with Vulnerability

As CCVI scores rose (moving from Very Low to Very High vulnerability), the count of MA plans offering non-medical transportation also went up. This suggests that plan providers might be more inclined to include these benefits in areas where they’re most urgently needed.

2. Relative Share of Plans

Not only did the total number of plans grow, but the percentage of plans that offer non-medical transportation also increased in higher vulnerability counties. In other words, it’s not just about having more plans overall—plans in these areas are more likely to include transportation as part of their benefits package.

3. Plan Data Gaps

The yellow and green bars (null or missing benefits data) are still significant. This raises questions:

• Is the data incomplete?Some plans may not have fully reported their supplemental benefits.

• Is there user or system error?Data entry issues could be causing discrepancies between enrollment data and benefits data.

Despite these gaps, the overarching trend is clear: communities with higher vulnerability scores see more plans that offer non-medical transportation—at least among those plans accurately reporting their benefits.

What’s Next?

• Parent Organizations: It would be fascinating to dive deeper into which parent organizations (i.e., major insurers) are leading the charge on transportation benefits. Are certain insurers more proactive in high-vulnerability counties?

• Local Focus: Drilling down to specific counties or states might reveal unique patterns. For instance, rural counties with poor public transit might show higher or lower uptake of these benefits than expected.

• Open Enrollment Implications: With the 2025 MA open enrollment around the corner, brokers and beneficiaries alike should be aware of which plans include transportation. A plan that covers trips to the grocery store, fitness centers, or community events could significantly improve a beneficiary’s quality of life.

Share Your Thoughts

• Are you seeing similar trends in your region or practice?

• Which parent organizations seem to be leading the way in offering non-medical transportation?

• What else would you like to see in future analyses?

I’d love to hear your insights, questions, and any additional observations. Understanding how social determinants of health—like transportation—impact seniors can help us all make more informed decisions and advocate for better benefits.

Final Takeaway

Transportation is more than just a ride; it’s a critical social determinant of health that can affect a senior’s well-being, independence, and sense of community. As the data suggests, Medicare Advantage plans in more vulnerable areas are stepping up to offer non-medical transportation. The hope is that this trend continues—and that data reporting improves—so seniors everywhere can have access to the resources they need to thrive.

Source data: [mimilabs Part C & D Enrollment files Feb-2024; benefits file 2024 Q1].