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 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 (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.Original Medicare (Medicare Parts A and B)
Medicare Advantage plans (Medicare Part C)
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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Related Posts:MEDICARE PART B
Medicare Part B covers ambulance transportation where:
1. A patient needs to get to a hospital or skilled nursing facility for medically necessary care; and
2. Any other type of transportation would endanger the health of the patient.
Medicare Part B will pay for non-emergency ambulance transport of a patient when the patient’s physician certifies in writing that any other of transportation would endanger the health of the patient. That is, the physician’s certification must expressly state that the non-emergency ambulance transport is medically necessary to ensure the health and safety of the patient.
In order for Medicare coverage to be guaranteed, it is imperative to obtain prior approval from Medicare Part B.
MEDICARE COVERAGE FOR NON-EMERGENCY AIR AMBULANCE
Medicare Part B covers a non-emergency air ambulance transport only if travel by long distance ground ambulance would present a serious danger to the patient’s health. The patient’s attending physician should make this certification in writing and prior approval from Medicare should be obtained.
MEDICARE PART C (MEDICARE ADVANTAGE PLAN)
Medicare Part C plans must cover everything covered under Medicare Part A and Part B. In some instances, Part C Medicare Advantage Plan may cover extended services or extended coverage. Contact the individual plan to ascertain if non-emergency patient transport is covered under the Part C plan and the requirements for coverage.
MEDICARE PAYMENT
Generally, Medicare will pay for 80% of the Medicare pre-approved cost of the ambulance transport. Ambulance providers cannot charge more than the Medicare approved amount. Medicare only pays for transportation to the closest appropriate facility that can provide the medical care required. Where a patient chooses hospital or medical facility further away, Medicare’s payment will be based on the cost of transportation to the nearest appropriate hospital or medical facility.
MEDICAL CARE REQUIREMENTS
• The care must be “medically necessary” for the patient and must be ordered or prescribed by a licensed physician or other authorized medical provider;
• Medicare (or a Medicare Part C plan) must agree that the care is necessary and proper.
• The care must be performed or delivered by an authorized Medicare healthcare provider (one who participates in Medicare).
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**About Air Ambulance America (AAA): Air Ambulance America is an authorized indirect Air Carrier (IAC) utilizing the services of licensed Part 121 and 135 air carriers to meet your air ambulance transportation need. AAA does not own,lease or operate aircraft, and has no affiliation with any direct air carrier. As an IAC, AAA contracts for the provision of air transportation services in its own name and coordinates the provision of medical services for your flight.