Does Medicare Cover Medical Transportation?
This article was updated on: 07/25/2017
Many aging adults and people with disabilities occasionally have trouble getting to and from the doctor or hospital for their medical care. They may no longer drive or are too ill to drive safely. If you’re a Medicare beneficiary here’s what you should know about emergency and non-emergency medical transportation.
What is emergency medical transportation?
You need emergency medical transportation if you’ve had a sudden health crisis or accident and your health is in serious danger, so much so that it may be harmful for you to ride in a car or taxi. Here are some situations in which emergency medical transportation is necessary:
- You are unconscious, in shock, or bleeding uncontrollably from an accident or injury.
- Your condition requires skilled medical care while you are en route to the hospital.
Emergency medical transportation also applies to emergency air transport if you are in a location that can’t be reached by a ground ambulance, or if traffic conditions are such that waiting for ground transportation could have life-threatening consequences.
What is non-emergency medical transportation?
Medical transportation to and from your doctor’s office, an outpatient facility, skilled nursing facility, or hospital for care for other than a life-threatening emergency all count as non-emergency medical transportation, according to Medicare. Even if you are ill and do not feel comfortable driving, or you’ve been discharged from the hospital after receiving treatment for an emergency, your situation does not usually qualify for emergency medical transport under Medicare. Here are some situations where emergency medical transport would generally not be appropriate (even though your doctor may say you shouldn’t drive yourself):
- You feel weak and dizzy after a chemotherapy treatment.
- You are being discharged from a surgery center after cataract surgery.
When does Medicare cover Emergency medical transport services?
Medicare covers medically necessary medical transportation to the closest hospital in the event of an emergency. Medicare Part B generally pays all but 20% of the Medicare-approved amount for most doctor services plus any Part B deductible. Ambulance companies must accept the Medicare-approved amount as payment in full. This also applies to emergency air medical transport services. If Medicare determines your condition did not warrant emergency medical transportation, it may not cover any of the costs.
In some very limited cases, Medicare will also cover non-emergency medical transport services by ambulance, but you must have a written order from your health-care provider stating that your medical condition requires transportation by ambulance.
Keep in mind that Medicare is testing a new program in a few states for beneficiaries who need scheduled, non-emergency medical transportation three or more times in a short period. In these states, the ambulance company is required to get prior authorization before a fourth ride is arranged; if Medicare denies authorization, and you still use the ambulance, the company may bill you in full for all charges. States and districts currently affected by the program include:
- New Jersey
- South Carolina
- District of Columbia
- West Virginia
- North Carolina
If you need help with non-emergency medical transportation and you qualify for Medicaid in addition to Medicare, you may be eligible for rides to and from your doctor’s office, the hospital, and other medical facilities for approved care. Consult your state program for help arranging these services. If you are not eligible for Medicaid, check with your city’s community services agency to see if free or low-cost medical transport services are available.
Do you have questions about Medicare coverage and getting medical transportation to and from the health-care services you need? I’m available to help you find answers. You can schedule a phone call or request an email by clicking one of the links below. To view a list of plans in your area you may qualify for, click the “Compare Plans” button. You can get immediate answers by calling me or one of our licensed insurance agents at 1-844-847-2660 (TTY users can call 711) Monday through Friday, 8AM to 8PM ET.