A Call for Medicare Coverage of Senior Citizen Driving Assessments

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A viewpoint by researchers at Brigham and Women’s Hospital in Boston made an argument for Medicare coverage of driving assessments for older, at-risk drivers. It was published Monday in JAMA Neurology.

Physicians may find it easy to revoke the license of a patient with moderate to severe dementia, but patients with mild cognitive decline may be trickier to spot, according to co-authors Kirk Daffner, M.D. and Margaret O’Connor, Ph.D. both from the department of neurology at Brigham and Women’s Hospital.

“[Healthcare professionals] must adjudicate whether patients are unfit to drive without having the most relevant information, which is direct observation of driving performance,” the co-authors write. “Performance on commonly used cognitive screening tests, such as the Mini-Mental State Examination, cannot predict the ability to drive.”

In 2020, there were about 65 million drivers in the United States over the age of 65. That year, this age group accounted for 7,480 driving-related deaths and 149,881 non-fatal injuries.

The authors said that a driving assessment should be treated no differently than a fall risk assessment. One fall risk assessment is covered by Medicare every year for beneficiaries with Part B coverage.

“Driving is a multifaceted activity that requires learned skills and the coordination of complex cognitive and physical functions,” Daffner said in a news release. “As we age, we are vulnerable to declines in our cognitive, visual and motor skills that can impact our ability to drive safely. Therefore, it is imperative to support programs in our healthcare system that can evaluate driving safety of at-risk individuals in a manner analogous to Medicare’s coverage of a fall risk assessment.”

In Massachusetts, driving risk assessments currently cost anywhere from $500 to $800. This cost could deter families, leaving potentially unsafe drivers on the road. These driving tests are not covered because they are not considered “medically necessary.” This is despite the fact that 17% (8.2 million) of people over the age of 65 experience cognitive impairment.

“Annual Medicare expenses for traumatic injuries in 2016 were estimated to be more than $16 billion, and motor vehicle crashes were the third-most leading cause of traumatic brain injury-related hospitalizations, emergency room visits, and deaths.”

Dental care and hearing aids are also not covered by Medicare, but the authors say driving assessments are of greater importance because impaired driving affects the driver and other people on the road.