Does Medicare Cover Non-Emergency Transportation?PolicyScout’s guide to non-emergency transportation and how Medicare can help provide coverage for it.
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Transportation plays an important role in many people's daily lives. You can use it to get to work, do grocery shopping, and visit the doctor. As you get older, though, getting around may become more difficult.
According to a PubMed Central study, of the 2.3 million older adults estimated to have a transportation disadvantage, 1.4 million (60%) relied on family or friends for transport to doctors’ appointments, while about 253,000 (11%) used a van or shuttle service for seniors.
This article will discuss Medicare’s coverage for transportation services, both for emergencies and non-emergencies, as well as other coverage options.
What Is Medicare?
Medicare is a U.S. federal health insurance program for people 65 or older, some younger people with disabilities, as well as people with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS.)
You can get Medicare coverage either through the government-run Original Medicare program, or you can get private coverage known as Medicare Advantage.
What Are the Different Parts of Medicare?
Medicare Part A refers to inpatient treatment and hospital care, including hospital stays, hospital treatments, and general nursing costs.
Medicare Part B relates to outpatient medical coverage and includes preventive treatments, doctors’ consultations, scans, and tests.
Medicare Advantage Plans
Part C/Medicare Advantage Plans are health plans offered by insurance companies that have contracts with Medicare.
These policies can cover Part A, B, and D expenses, including costs for hospital care, prescription drug coverage, and doctors’ visits.
Prescription Drug Plans (PDPs)
Stand-alone Part D Plans (Prescription Drug Plans) cover self-administered prescription drugs. For example, medications for high blood pressure, pain tablets, and antidepressants.
Medicare Supplement Insurance (Medigap)
A type of insurance sold by private insurance companies to cover any gaps in Original Medicare coverage. Some medical expenses that the Original Medicare Plan does not cover are covered by Medigap plans.
Does Medicare Cover Medical Transportation Services?
Some modes of transportation are covered by Medicare for beneficiaries who require medical health care services.
Both emergency and non-emergency medical transportation (NEMT) may be covered; however, it is more common for Medicare to cover emergency medical transportation.
Emergency ambulance transportation is covered by both Original Medicare (Parts A and B) and Medicare Advantage.
Original Medicare usually does not cover non-emergency situations unless they are pre-approved. Medicare Advantage, on the other hand, may cover this service as an added benefit.
Emergency Medical Transportation vs. Non-emergency Medical Transportation (NEMT)
Emergency medical transportation is transportation provided when life, health, or safety is in danger, such as ambulance or law enforcement transportation.
Non-emergency medical transportation includes transportation services offered to patients and health care users who need assistance or face barriers that prevent them from getting to their medical appointments.
Medicare Coverage of Emergency Medical Transportation
Part B of Original Medicare provides coverage for emergency ambulance transportation to the nearest appropriate medical facility.
According to the Centers for Medicare & Medicaid Services (CMS), Medicare typically provides ambulance coverage to and from the following places:
|A person’s home
|The nearest health care professional
|A skilled nursing facility (SNF)
|The nearest appropriate renal dialysis facility
|A person’s home (roundtrip included)
Your transportation will be covered if you match any of the following criteria:
There is a sudden medical crisis
There is a severe risk to a person’s health
Moving a person from one location to another may be impossible without the help of emergency services
A person is losing a lot of blood, unconscious, or in shock
A person is set to receive a Medicare-covered service
A person is traveling to and from sites that are covered by Medicare
The ambulance service meets Medicare requirements
Ground transportation may not always be the most efficient means of getting you the emergency care you require. In some situations, Part B may cover the cost of an emergency helicopter or airplane transportation.
If you require emergency medical transportation, you will have to pay 20% of the cost (coinsurance) after you have met your Part B deductible, which is $233 in 2022.
Medicare Advantage programs cover the same benefits as Original Medicare, including emergency medical transportation. However, depending on the plan, the rules or needs for emergency medical transportation may differ.
Terms You Should Know
Premium: A recurring payment for your Medicare, Medicare Supplement, or Medicare Advantage plan to get continued coverage.
Coinsurance: Your share of the costs of a covered health care service. The amount is calculated as a percentage of the allowed amount for the service.
For example, if your coinsurance is 20%, you would pay 20% and Medicare takes care of the other 80%.
Deductible: The amount that you must pay for health care or prescriptions before Original Medicare, a prescription drug plan, or your other health insurance begins to pay.
In Original Medicare, you are required to pay a deductible for each new benefit period for Part A and for each year for Part B.
Skilled nursing facility (SNF): A skilled nursing facility is an in-patient rehabilitation and medical treatment center staffed with trained medical professionals for the residential care of elderly or disabled people.
Medicare Coverage of Non-emergency Medical Transportation
Medicare Part B may also cover non-emergency medical transportation (NEMT) services. However, for Medicare to provide coverage, you would need to get a certificate from your doctor saying that ambulance transportation is medically required.
This could happen, for example, if a person requires monitoring of their vital signs during a trip, if someone needs dialysis on their route to the hospital, or if a person needs help getting to medical appointments.
What Is Dialysis?
Dialysis is a medical procedure that removes excess water, solutes, and toxins from the blood in persons whose kidneys are unable to do so naturally.
A person may also need to apply for NEMT when they are unable to:
Stand without assistance
Sit in a wheelchair or chair
If the reason for your transportation is not a medical emergency, the company transporting you might require you to sign an Advance Beneficiary Notice of Noncoverage (ABN).
ABNs are typically given to people when:
You’re using an ambulance in a non-emergency situation
The ambulance service believes Medicare will not cover the cost of the particular ambulance ride
Some states require patients to pay a co-payment for the transportation service. This is usually a fee ranging from $0.50 to $3.50 per trip, according to the Kaiser Family Foundation.
What Is an Advance Beneficiary Notice of Noncoverage (ABN)?
Before providing a service or product for which Medicare may deny payment, a doctor, supplier, or provider must give notice to Medicare.
You may not have to pay for a service or product if you are not issued an ABN before receiving it and Medicare denies payment.
If you are given an ABN and sign the notice, you will almost certainly be responsible for paying for the item or service if Medicare refuses to pay.
An ABN is only applicable if you are enrolled in Original Medicare (Parts A and B).
NEMT services to a doctor's office or clinic may be covered by Medicare Advantage Plans. However, this service may be covered only if it is provided to a place that your plan has approved.
Because rules and standards can differ, it's crucial to double-check your Medicare plan to determine what's covered.
Skilled Nursing Facilities and Transport
Skilled nursing facilities (SNFs) provide expert nursing services to treat, manage, and oversee medical conditions, as well as evaluate care for patients who require it.
SNFs supply a higher level of medical care compared to assisted living facilities.
Medicare may cover non-emergency trips if a person lives in a skilled nursing facility.
When a person has Medicare Part A, the SNF should pay for transportation fees provided that a doctor writes a note stating that travel is required.
The facility should not charge Medicare for transport services.
An ambulette is a van that can accommodate a wheelchair and provides non-emergency transport.
Medicare does not cover ambulette services.
Emergency Air Transport
If a person requires immediate transportation that a ground ambulance cannot give, they may need to be transported by helicopter or airplane.
If a person needs to fly to the hospital for medical reasons, Medicare may pay for these services if ground transportation providers cannot reach the facility because of:
bad weather impacting the roads
a distance that is too long to cover by road in time to save the person’s life
How to Get Non-emergency Medical Transportation with Medicaid
The first step you will need to take to get non-emergency medical transportation with supplementary medical insurance would be to call your transportation providers and set up your needed ride in advance.
If you need to reschedule or cancel the transportation, you should also give your transportation providers a call.
Once your ride has been arranged, the driver can provide you or an eligible family member with a trip to and from a medical office.
Note: If the driver gives you a ride anywhere else that is not to and from the medical facility, you will not receive mileage reimbursement. Rather, you and the driver could be charged with defrauding Medicaid.
Follow these steps to ensure that Medicaid approves and pays for your ride. Drivers may only be authorized to pick up their passengers at specified hours; therefore, it is important to:
Be ready on time for the pickup
Call the ride service to cancel a scheduled ride if you do not need the ride anymore
In some states, Medicaid might not pay for the time a driver has to wait for you to arrive, or if you do not show up for a scheduled pickup. In other states, there may be limits on how long the driver can wait for you if you are not on time.
If you have a pattern of missing booked rides, you may need to phone the ride provider multiple times, or find it difficult to confirm future medical appointments.
Medicaid may also place further restrictions on your ability to receive reliable transportation, such as requiring you to use only one service.
Does Medicare Advantage Cover Non-emergency Medical Transportation?
Medicare Advantage offers the same coverage and provides the same benefits as Original Medicare, but through private insurance companies.
This means that you would receive the same emergency and non-emergency medical transportation under Medicare Advantage as you would under Original Medicare.
Medicaid of Non-emergency Transportation
Medicaid, or Medicare Supplementary Insurance, is a federal program that assists low-income people with health care costs. Like Medicare, Medicaid covers the cost of emergency ambulance transportation.
Medicaid services can also cover non-emergency medical transportation to a doctor’s office or clinic. However, you may have to meet certain requirements for coverage of non-emergency medical transportation.
For example, Medicaid may provide transport cover if you:
Don’t have a car
Don’t have a driver’s license
Have a physical or mental disability
Can’t travel or wait for a ride by yourself
The type of transport provided may vary but can include a car, van, taxi, bus, or the subway.
Supplemental Transportation Benefits of Medicare Advantage
CMS expanded Medicare Advantage businesses' ability to provide transportation services in 2019.
This enables businesses to incorporate transportation for things like nutrition and well-being, such as trips to therapeutic massage appointments or the supermarket.
In 2021, nearly 50% of Medicare Advantage Plans offered some supplemental transportation benefits.
Because not all Medicare Advantage Plans provide these additional transportation alternatives, and because they may vary from plan to plan, a person should find out and learn more about their plan's specific features.
Where to Find Other Medicare Plans
Understanding the importance of transportation, especially in an emergency, could be a key factor in deciding which Medicare plan you decide to choose.
If you want to learn more about Original Medicare, Medicare Advantage Plans, or anything Medicare-related, head to PolicyScout’s Medicare hub to compare your options and find the best plan in your area.