How Medicare Covers Emergency and Non-Emergency Transportation
- Though Medicare Part B only covers emergency ambulance transportation, some private Medicare Advantage plans may cover non-emergency transportation, such as trips to the doctor’s office.
Medicare covers a wide range of services and items while at the hospital or doctor’s office. But what does Medicare cover to actually get you there?
This article addresses how Medicare covers transportation services in both emergency and non-emergency situations, including ambulance rides to the hospital and transportation to a doctor’s office.
When Does Medicare Part B Pay for Ambulance Transportation?
Ground ambulance transportation is covered by Medicare Part B if you must be taken to a hospital, critical access hospital or skilled nursing facility for medically necessary services and when transportation by any other vehicle could endanger your health.
Ambulance transportation by airplane or helicopter – sometimes referred to as emergency airlift transport – is covered by Medicare Part B if rapid transportation is medically necessary and can’t be provided via ground transportation.
Non-emergency ambulance transportation may be covered by Part B if you have a written order from a doctor stating that the transportation is medically necessary. An example of covered non-emergency transportation might be if a beneficiary who is on dialysis needs transportation to a dialysis facility but has no other means to get there.
If you receive non-emergency ambulance transportation and the ambulance company believes it may not be covered by Medicare, you must receive an Advance Beneficiary Notice of Noncoverage (ABN).
Whether it’s an emergency or non-emergency situation, Medicare will only cover ambulance transportation to the nearest appropriate medical facility that is able to provide the required care.
After you meet your annual Part B deductible (which is $198 for the year in 2020), you’re typically responsible for paying a 20% coinsurance payment for the cost of the ambulance ride.
Some Medicare Advantage Plans Also Cover Non-Emergency Transportation
Some Medicare Advantage (Medicare Part C) plans may cover non-emergency medical transportation to doctor’s office appointments, physical therapy sessions and even the pharmacy. Some plans may partner with ride-sharing companies such as Lyft to provide this covered benefit.
This benefit came as a result of a 2018 ruling by the Centers for Medicare & Medicaid Services (CMS) to allow Medicare Advantage plans to begin including non-emergency medical transportation (NEMT) as a covered benefit.
Private Medicare Advantage plans are required by law to include all of the same benefits covered by Medicare Part A and Part B (known as Original Medicare), which are provided by the federal government. This means Medicare Advantage plan beneficiaries also have the same emergency transportation coverage detailed above by Original Medicare, in addition to any additional non-emergency transportation that their plan covers that isn’t covered by Original Medicare.
Medicaid May Cover Non-Emergency Transportation
Some Medicare beneficiaries are “dual eligible,” which means they are eligible for both Medicare and Medicaid benefits.
While Medicaid coverage varies from state to state, federal regulations require state Medicaid programs to cover non-emergency medical transportation when necessary. Depending on the state, the medical transportation services Medicaid covers may include taxis, buses, vans and personal vehicles belonging to family or friends.