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. 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.) H8764_MKT_TransportationService_Blog_0721_C Related Posts:Rides to routine medical appointments generally aren't covered on Original Medicare — and they’re covered on only some Medicare Advantage plans. However, both Original Medicare and Medicare Advantage cover emergency and certain nonemergency ambulance transportation. When does Medicare cover nonemergency transportation?Original Medicare doesn’t cover rides to routine medical appointments, like annual physicals, follow-ups or urgent care visits. In certain circumstances, however, Medicare Part B may cover medically necessary, but nonemergency, ambulance transportation, such as a ride to dialysis for someone with end-stage kidney disease. Before you can be approved for ambulance rides, you’ll need a letter from your doctor stating that this transportation is a medical necessity — and if approved, you’re covered only for rides to and from the nearest Medicare-eligible medical facility that handles your specific condition. If you arrange nonemergency ambulance services that the ambulance company suspects Medicare won’t cover, you’ll receive an Advance Beneficiary Notice of Noncoverage as a warning that you may be responsible for the bill. Additionally, if you live in certain states and book three or more nonemergency round trips in a 10-day stretch or at least one round trip per week for three weeks or longer, the ambulance company may ask you for prior Medicare authorization before a fourth trip to make sure you’ll be covered. You can also request prior authorization for nonemergency ambulance transportation from Medicare directly. How much does nonemergency transportation cost with Original Medicare?If approved for nonemergency transportation through Original Medicare, you’re responsible for meeting the Medicare Part B deductible of $233 in 2022 ($226 in 2023), along with 20% of your Medicare-approved costs. Does Medicare Advantage cover nonemergency transportation?Medicare Advantage plans are required to provide the same coverage as Original Medicare, so all Medicare Advantage plans will at the very least cover the same types of nonemergency ambulance transportation as Original Medicare. Since Medicare Advantage plans are offered by private insurance companies, any coverage that goes beyond Original Medicare (as well as required copays, coinsurance and deductibles) will vary from insurer to insurer, and from plan to plan. Some Medicare Advantage plans do cover health-related transportation — not only to routine medical appointments, but also to pharmacies to pick up prescriptions — and sometimes even to gyms. Depending on your Medicare Advantage policy, you may be able to hire ride-sharing services (like Lyft or Uber), taxis or vans to get to and from your appointments with a low or $0 copay, resulting in little or no out-of-pocket cost. What do private transportation services cost?The cost of hiring a ride to get to a medical appointment varies widely based on factors including miles, tolls, the type of vehicle and whether you need special accommodations like a wheelchair or a stretcher. Each company has its own method of calculating rates, but to get a rough idea: A full-priced trip of about 10 miles to a local hospital in the Northeast could cost around $14-$21 each way with Lyft or Uber, while travel with a private medical transportation company with required accommodations could run $200 or more for a round trip, including wait time. If you need to hire private transportation, it pays to shop around in advance to find the most reasonable available option. Are there affordable transportation alternatives?If you need nonemergency medical transportation that your Medicare plan doesn’t cover and you aren’t able to afford commercial rides, a number of organizations nationwide provide free or low-cost transportation.
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048). |
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