The transportation Medicare pays for can depend on the situation. Medicare typically 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.
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:
|a person’s home||a hospital or skilled nursing facility (SNF)|
|the nearest healthcare professional||an SNF|
|the nearest appropriate renal dialysis facility||a person’s home (roundtrip included)|
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.
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
- 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.
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.