Does medicare provide transportation to medical appointments

As you approach the age of 65 you might be concerned with transportation to your doctor’s appointments or the hospital, and Medicare coverage for transportation services. It is important to know what choices are available to you. Does Medicare cover transportation? Yes and no. Let’s break down transportation coverage by Medicare type:

Original Medicare (Medicare Parts A and B)

Original Medicare covers emergency transportation including ambulance services under Medicare Part B if you need to be transported to a hospital, critical access hospital or skilled nursing facility (SNF) for medically necessary services and transportation by any other vehicle could endanger your health. The ambulance will take you to the nearest medical center that can treat you.  A sudden, serious medical emergency such as heavy bleeding or shock requiring care on the way to the hospital is also covered. If ground transportation is not fast enough, Medicare can also cover air ambulance (helicopter or plane).

Original Medicare does not generally cover non-emergency transportation including rides to doctor’s appointments or physical therapy. They will only cover non-emergency ambulance services if you have a written order from your doctor stating that this transportation is medically necessary.

For patients with end stage renal disease (ESRD) who require dialysis, Original Medicare covers ambulance services from your home to the nearest dialysis facility if other transportation could endanger your health. For non-emergency transportation (scheduled, repetitive ambulance services), you must receive a written notice from your doctor that this transportation is medically necessary.

Medicare Advantage plans (Medicare Part C)

Medicare Advantage (MA) plans cover everything that Original Medicare covers, so this means that MA plans cover emergency transportation. Note that ambulance costs do vary by plan.

MA plans are able to offer extra benefits that Original Medicare does not cover, including non-emergency transportation – trips to doctor’s appointments, physical therapy, pharmacies, or hospitals. Some plans offer this as an enhanced benefit and others include it in their core product. As coverage varies by plan, check all MA plan options in your area to see what they offer.

MA plans may also cover non-ambulance transportation to dialysis facilities and to see your doctors. Since 2021, Medicare beneficiaries ESRD can now enroll in an MA plans. Check with your plan to see what they offer.

Medicare Supplement plans (MedSupp)

Medicare supplemental insurance plans (aka MedSupp or Medigap) do not cover transportation. A Medicare Part B deductible applies to any ambulance ride, so you are responsible for the deductible amount before Medicare pays, and you are responsible for 20 percent of the Medicare-approved amount. Since MedSupp plans are sold by private health insurers to fill in coverage gaps in Original Medicare, they can help pay for any out-of-pocket Medicare costs including deductibles and copays.

There are also local community programs available to provide rides to doctor’s appointments. Many of these programs are run by volunteers or non-profits, and you can usually call your local Alliance on Aging for assistance. Aspire Health Plan members can call Member Services using the phone number on the back of your ID card for any assistance. Members also have no-cost access to an enhanced care team including social workers who can help connect you with medical and non-medical resources and more.

We understand that Medicare coverage and transportation may be a little tricky. To make the most of Medicare, you need to understand your options and how they work. Aspire Health Plan is here to answer any Medicare questions you may have. Give us a call at your convenience for friendly, no-obligation advice. Call (855) 378-9680. (TTY users call 711.)

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Medicare covers emergency and nonemergency medical transport, as long as it is medically necessary and meets specific requirements.

Medicare Part B covers the ground or air ambulance services that a person may need in a medical emergency. In specific circumstances, Medicare may also cover nonemergency medical transportation.

This article will look at how Medicare covers emergency and nonemergency medical transportation costs and under what circumstances the plan will generally approve coverage.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

• Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
• Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
• Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Medicare Part B covers emergency and nonemergency ambulance services when they are medically necessary. In those cases, Medicare covers 80% of eligible transport costs.

A person may then have to pay the remaining 20% as coinsurance. The coinsurance will usually apply after a person pays the Part B deductible in full.

According to the Centers for Medicare & Medicaid Services (CMS), Medicare typically provides ambulance coverage to and from the following places:

Emergency transportation

Per CMS, Medicare Part B will typically cover ambulance services when:

• 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 the emergency services.
• A person is losing a lot of blood, unconscious, or in shock.
• An individual is set to receive a Medicare-covered service.
• A person is going to and from locations within the Medicare coverage guidelines.
• The ambulance service meets Medicare requirements.

Nonemergency transportation

A person can get nonemergency medical transportation covered by Medicare if they have a written order from a doctor stating that it is medically necessary.

This may happen when a person needs vital medical services during a trip, such as the monitoring of vital functions. This could also occur, for example, when a person requires dialysis on the way to the hospital.

A person may also need this when they are unable to:

• stand without assistance
• walk
• sit in a wheelchair or chair

Skilled nursing facilities and transport

If a person lives in a skilled nursing facility, Medicare may cover nonemergency trips.

A doctor must provide a letter to advise that travel is necessary, and, when a person has Medicare Part A, the SNF should pay for transport costs.

The facility should not charge Medicare for transport services.

Ambulettes

Medicare does not cover ambulette services.

An ambulette is a van that can accommodate a wheelchair and provides nonemergency transport.

Emergency air transport

A person may need transportation by helicopter or airplane if they need immediate and rapid transportation that a ground ambulance cannot provide.

If a person is medically required to travel to the hospital by air, Medicare may pay for these services, provided that ground transport cannot reach the location due to:

• heavy traffic
• bad weather impacting the roads
• a distance that is too long to reach by ground in time to save the person’s life

Medicare Advantage covers the same benefits as original Medicare, but through private insurance companies. These plans must offer at least the same coverage as original Medicare.

This means that a person would receive the same emergency and nonemergency transportation under Medicare Advantage as they would under original Medicare.

However, Medicare Advantage companies may require a person to choose in-network ambulance services to receive full reimbursement.

Nonemergency medical transportation

Nonemergency medical transportation helps people who need help getting to and from medical appointments, per CMS.

It is primarily a benefit of the Medicaid program, but some Medicare Advantage plans also offer this benefit. A person can check with their specific Medicare Advantage plan to see if it offers nonemergency medical transport.

Supplemental transportation benefits

In 2019, CMS expanded the abilities of Medicare Advantage companies to provide transportation services.

CMS changed the wording of some of its policies so Medicare Advantage companies could cover transportation to services that are “primarily health related.”

This allows companies to include transportation for things including nutrition or wellness, such as transportation to a therapeutic massage appointment or even a trip to the grocery store.

Ride-sharing companies, such as Lyft, have even partnered with some Medicare Advantage programs to provide transportation.

In 2021, 47% of Medicare Advantage plans offer some supplemental transportation benefits.

Since not all Medicare Advantage plans offer these extended transportation options, and they may differ from plan to plan, a person should call to learn the specific benefits of their plan.

When a person can, they may drive themselves or use public transportation to get a medical appointment.

In cases when an individual who requires transport has a disability, is an older adult who no longer drives, or is someone with a lower income who doesn’t have Medicare, they may be able to get medical transportation in the following ways:

• if they have Medicaid, through nonemergency medical transport
• taxis or ride-sharing companies like Lyft and Uber, and transportation voucher programs may be available to help with the cost
• Dial-a-ride, which requires advance reservation and sharing the ride with others
• Paratransit, in which a personal care assistant will help a person with a disability through the public transit system
• local transportation programs by nonprofit or religious organizations that may assist with the transport, help with the cost, or both

Medicare Part B may cover emergency transport by road or air ambulance if a healthcare professional deems it medically necessary and under certain conditions.

Medicare may also consider coverage for nonemergency transport if a person is immobile or requires specific medication.

In most cases, a person may need a letter from a doctor stating that the ambulance or air transport is medically necessary.

Under some Medicare Advantage plans, a person may get certain additional medical transportation coverage. This is usually coverage for nonemergency transportation and may vary from plan to plan.

People who need it may also try to get additional non-Medicare transportation assistance and financial support. A person should check available resources in their area.