Medicare Coverage of Nonemergency Transportation
Some seniors, due to the general frailty, mental incapacity, or the effects of a medical condition, can no longer drive or otherwise handle transportation or their own. Nonemergency transportation of a patient to and from home is typically not considered a medical service, but there are certain situations that deem transportation services medically necessary even in nonemergency situations.
Nonemergency Transportation Services Covered by Medicare
Neither Medicare Part A nor Medicare Part B covers routine transportation for a patient to or from home in nonemergency situations. However, Medicare Part B sometimes covers nonemergency ambulance transportation between home and a hospital or other place of treatment or diagnosis if the patient’s doctor certifies in writing that transportation in something other than an ambulance would endanger the patient’s health or is medically necessary, such as in the case of transporting a patient with End-Stage Renal Disease to a dialysis facility.
A written statement by a doctor is necessary for Medicare Part B coverage of nonemergency ambulance coverage, but it doesn’t guarantee Medicare coverage. To be certain of coverage for nonemergency ambulance transportation, ask the treating physician’s office to get prior approval from Medicare Part B. If a patient hires ambulance transportation but it isn’t approved by Medicare Part B, the patient could be personally responsible for the full cost.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that’s included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments, contact the plan directly.
What Medicare Pays for Nonemergency Transportation
Medicare pays nothing for most nonemergency transportation. Medicare Part B pays 80 percent of the Medicare-approved amount for nonemergency ambulance services if it approves those services based on a written statement of medical necessity from the patient’s doctor.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet three basic requirements:
- The care must be “medically necessary.” This means that it must be ordered or prescribed by a licensed physician or another authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
- The care must be performed or delivered by a healthcare provider who participates in Medicare.
- Medicare will only cover ambulance services to the nearest appropriate medical facility that is able to provide the care you need.