Geographic variation in Medicare Advantage nonemergency medical transportation benefits 2020-2024

Abstract

Abstract Introduction Nonemergency medical transportation (NEMT) is a supplemental benefit in Medicare Advantage (MA) plans that helps individuals overcome transportation barriers to healthcare services. It remains unclear whether these benefits are targeted to communities with greater needs. Methods We analyzed MA plan benefit data from 2020 to 2024 across 2764 US counties. Transportation barriers were assessed using 5 indicators: vehicle ownership, income levels, self-reported health status, avoidable hospital visits, and access to primary care. We examined trends in NEMT availability and its alignment with county-level transportation need, considering MA plan penetration as a modifying factor. Results Nonemergency medical transportation benefit prevalence in MA plans increased by 13.88% points from 2020 to 2024. In 2024, counties with the greatest transportation barriers had a 19.4% point higher prevalence of NEMT offerings compared to counties with the fewest barriers. Alignment was stronger in counties with higher MA plan penetration. Conclusion Medicare Advantage plans increasingly offer NEMT benefits in areas with greater transportation challenges, especially where MA plan penetration is higher. These findings suggest responsiveness to social needs and the potential role of market dynamics. Policymakers can support equitable access by incorporating transportation needs into MA plan evaluations.