Medicare provides coverage for certain types of medical transportation, including emergency ambulance services and some cases of non-emergent transport.
Medigap and Medicare Advantage may offer additional financial assistance. However, these plans vary, and individuals need to check the specifics of their coverage.
Read on for a comprehensive guide on what types of transportation Medicare covers, including the costs involved and your options if Medicare does not cover your transportation needs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medical transportation refers to services that help individuals get to and from medical appointments or emergency rooms.
Ambulances typically provide emergency medical transportation. A helicopter may provide transport in critical cases where an individual needs more immediate medical attention.
Non-emergent medical transportation is when a person needs transportation for medical purposes but does not need urgent care.
For example, someone who is unable to walk or use a wheelchair may require a non-emergent ambulance ride to a healthcare appointment. Additionally, a person with end stage renal disease may need regular transport to and from a dialysis center.
Original Medicare, specifically Medicare Part B, covers several types of medical transportation.
Emergency
Original Medicare covers emergency ground ambulance transportation when any other type of transportation could pose a risk to a person’s health.
This includes transportation to hospitals, rural emergency hospitals, or critical access hospitals. It is important to note that Medicare will only cover ambulance transportation to the nearest appropriate medical facility.
If ground transportation is not fast enough, Medicare may also cover air ambulance services such as helicopter transportation.
Non-emergency
Original Medicare also has specific situations in which it covers non-emergency transportation. However, for Medicare to cover the transportation, a doctor must give a written order specifying that this type of transportation is medically necessary.
For example, individuals with severe mobility issues or those undergoing regular treatments such as dialysis may qualify for non-emergency ambulance services if no other mode of transport is suitable.
The ambulance company must provide a person with Advance Beneficial Notice of Noncoverage (ABN) if both of the following apply:
- a person gets ambulance services in non-emergency situations
- the ambulance company believes that Medicare will refuse to pay for the specific ambulance service
Prior authorizationThe ambulance company may need to send a request for authorization to Medicare if a person gets non-emergency ambulance transportation:
- for three or more round trips in a 10-day period
- at least once a week or 3 or more weeks
The ambulance may send this request before the fourth round trip in a 30-day period.
Medicare Advantage plans, also known as Medicare Part C, may offer additional benefits for medical transportation that Medicare does not cover.
Private insurance companies provide these plans and may cover non-emergency transportation such as rides to healthcare appointments or pharmacies.
However, the specifics of what these plans cover vary by plan, and not all plans include transportation coverage. It is important for an individual to check with their insurance provider to understand what services their Medicare Advantage plan covers.
Medigap, or Medicare Supplement Insurance, helps cover some of the costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles.
However, Medigap generally does not cover medical transportation unless it is a service that Medicare already covers. For example, if Medicare covers 80% of a medically necessary ambulance ride, Medigap may cover some or all of the remaining 20%, depending on the plan.
When someone with Medicare uses medical transportation services, their out-of-pocket costs include the Part B deductible and 20% of the amount Medicare approves.
It is important to note that the actual costs can vary according to what the ambulance company charges if they do not accept the Medicare assignment. In some cases, this leads to additional expenses beyond the standard 20%.
These costs can vary depending on:
- if the person has additional insurance coverage
- the type of transport someone needs
- how far the transport travels
- if the doctor accepts Medicare
- the location of the services
To ensure that Medicare covers the cost of transportation, a person needs to check that the services are medically necessary and meet Medicare’s guidelines.
For non-emergent transportation, the individual needs to get a written order from their doctor detailing why the service is necessary.
They also need to confirm that the transport provider accepts Medicare.
The individual also needs to meet their portion of the Part B deductible and pay the 20% coinsurance.
If Medicare is not going to cover a person’s transportation needs, there are other options to explore.
Some state Medicaid programs offer assistance with transportation for individuals whose income level is eligible for these services.
Other areas to explore include:
- local nonprofits
- community organizations
- ride-sharing services such as Uber Health
A person can ask their doctor for a list of local resources that may provide transportation services at a reduced cost or even for free.
Does Medicare cover mileage reimbursement?
No, Medicare does not cover mileage reimbursement for personal vehicles. However, some Medicare Advantage plans may cover transportation to medical appointments.
What types of aftercare or equipment associated with medical transportation will Medicare cover?
Medicare covers medical services and equipment necessary for transport. These may include stretchers, oxygen, or intravenous (IV) medications that healthcare professionals administer to the veins. However, this coverage typically applies only when an ambulance or other emergency transport is providing the service.
Medicare offers coverage for emergencies and, in specific cases, non-emergency medical transportation when using an alternative method of transport may endanger the person’s health.
While Original Medicare covers essential ambulance services, Medicare Advantage plans may provide additional coverage depending on the plan.
Medigap and Medicaid may help offset out-of-pocket costs, including deductibles and coinsurance.
Understanding what Medicare covers and how to obtain the necessary transportation services is important for managing transportation needs under Medicare.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.