Supplemental benefits like vision care, transportation services, and dental care are key reasons why more people today opt for a Medicare Advantage plan versus traditional Medicare (54% v. 46%). However, there isn’t much data about how those benefits are actually used. Given this gap and others, the Public Policy Lab set out, with funding from The SCAN Foundation, to collect meaningful data about the country’s older population and their needs—in their own words.
The People Say is an online database of firsthand stories, data, and insights from 71 older adults, 7 caregivers, and 13 subject matter experts in the U.S. about the issues impacting this population. The goal was to document lived experiences and to identify areas where society and the healthcare system could better meet the needs of the country’s seniors.
“More than 17% of people in America are 65 or older, yet public policy and programs are typically designed for them, not with them,” the authors wrote. “We believe that if policymakers can be presented with compelling data illuminating the real needs of older adults — and, importantly, how those needs evolve over time — they'll be more likely to act.”
The participants were chosen from diverse areas in terms of geography, population density, and political leanings, pulled from states where at least 10.7% of the population is dually eligible for both Medicare and Medicaid. The participants recorded hours of audio and video interviews and independently completed worksheets about their lives and health.
The 10 insights cleaned from the research revolve around:
- Aspirations for Older Age
- Social Connection
- Caregiver Support
- Transportation Access
- Housing Access & Suitability
- Finances for Basic Needs
- Comprehensive & Seamless Healthcare Coverage
- Navigation of Healthcare Benefits & Coverage
- Mental Health Services
- Trust in Clinicians
Ultimately the goal is concrete action: “By developing the right kind of public data, from the highest priority populations, while building a coalition of committed partners to use that data, The People Say hopes to shift the conversation on what needs to be done to build a society that works for older adults, their families, and all of us.”
The Need for Better Transportation Access for Seniors
While all the issues confronting the senior population are pressing, SafeRide Health is a nationwide partner for non-emergency medical transportation, focused on ensuring people have seamless access to transportation so they can get the care they need.
To that end, the research project uncovered various themes around transportation access:
- “The inability to drive is a notable loss for many older adults.” As vision and hearing gets worse and reaction times slow with age, driving becomes more precarious for seniors. Sometimes it is their choice to stop driving, because they no longer feel comfortable behind the wheel; other times they are forced to stop operating motor vehicles. In some cases, older adults on a fixed income can no longer afford to own a car. Whatever the reason, the inability to drive takes away some of their independence and control, and that can be a difficult shift in their lives. “I had a truck. I had a car too. But it gave me so much trouble, I got rid of it,” said Tony, an Alabama resident in his 70s who took part in the study. “I'm used to getting up and going where I want to go. [Now] I have to ask somebody, pay somebody to take me places.”
- Unreliable, unsafe, or nonexistent transportation services can demoralize older adults and leave them without options. Without the ability to drive themselves, seniors become more reliant on others to get them where they need to go. Some do have access to non-emergency medical transportation (NEMT) benefits through their Medicare Advantage or Medicaid plan (or both, if they are dual-eligible members), which provides rides to approved locations. For those who don’t have NEMT benefits, they must find a caregiver or friend to give them a ride, use public transportation, or order a rideshare ride to get to their medical appointments. That can be confusing and humbling for people trying to get the care they need. One participant, Donna, who lives in Texas and is in her 60s, said she had broken her toe, but didn’t know how to get to the podiatrist: “Somebody said I should go to urgent care rather than going to the emergency room. But again, getting there . . .. A lot of my friends are too, you know, they’re busy.”
- There are significant costs of limited transportation access. It often takes resourcefulness to find transportation so people can access the care they need— and it can be even more challenging for those managing a chronic condition and multiple appointments every week. For those who can’t find a solution, the cost can be missed appointments and worse health outcomes. In 2017, 5.8 million people in the U.S. delayed medical care because of transportation challenges. “I was in dialysis three days a week, I was going to cancer treatments two days a week, and I was having trouble trying to get there,” said Sam, who is in her 70s, lives in Iowa, and has a Medicare Advantage plan. “I couldn't afford to do that because they wanted anything from $35 to $60 one way. I can't afford that. I can't afford to have [my sister] get off her job five times a week to take me somewhere and then bring me back. Finally, I did find a place where they said they will charge me $7 for a round trip. Which doesn't sound like that much . . . but my only payment is Social Security, which is $1,300 a month. But I’ve got to pay them $7, and that's five days a week.” This was a common theme among seniors living on a fixed income, who are sometimes forced to choose between paying for basic needs and going to the doctor.
- What helps? Many people in the research study said that they relied on family and friends to help them get where they need to go. One woman, Sally, who is in her 70s and is dually eligible for both Medicare and Medicaid, said in a 2023 interview that her sister had been driving her to her appointments but then she started using NEMT service: “I've been using that Humana ride service. I get 24 one-way [rides],” she said. “[I] call up Humana and tell them where I want to go.” Tony, the Alabama resident, also used NEMT services: “Only thing I had to do was call them and tell them. Like if I got to go to Montgomery, I'll call them and tell them. Somebody will help me out calling them,” he said. “I’ll tell them what time I’ve got to go. They'll come down and pick me up, take me.”
One participant said her NEMT experiences had been inconsistent—a common industry complaint. SafeRide was founded in 2016 to ensure we do not contribute to that problem, and our results show measurable improvements in member experience. The participants who had used NEMT did all agree that the benefit made a real difference in their ability to get to care and reduced the stress of finding someone else to take them. Beyond the need for transportation, the study found that older patients found the healthcare system difficult to navigate and confusing, which sometimes caused them to miss out on available benefits.
When it comes to meeting the needs of the country’s growing senior population, SafeRide Health is focused on working with health plans to ensure their transportation benefits meet the needs of the plan and its members. That means they are easy to use, with self-service options for people who want more autonomy; that members have a pleasant and reliable transportation experience; and that patients understand what is covered and have the resources they need to get where they need to go.