Medicare

How Does Medicare Cover Transportation?

How Does Medicare Cover Transportation?

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Original Medicare (Part B) covers medical transportation provided by ambulance to a covered destination for medically necessary services. Medicare Part B covers most emergency and some non-emergency transportation needs. Many Medicare Advantage plans expand the benefit to include even more transport methods and destinations, such as a rideshare service to an approved fitness center.

Understanding how Medicare transportation coverage and payments are handled by the different programs can help you estimate out-of-pocket expenses for these services.

Does Medicare cover emergency transportation?

Original Medicare Part B (medical insurance) covers ambulance transportation for Medicare patients. Specifically, it pays for emergency ground ambulance transport to a hospital, critical access hospital or skilled nursing facility for medically necessary services, when transportation in another vehicle could risk your health.

Medicare may pay for an emergency air ambulance to a hospital if you need a quick and urgent response that ground transportation can’t provide.

What is classified as an emergency under Medicare?

In general, Medicare considers a situation to be an emergency 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, is unconscious or is in shock.
  • An individual is 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.
  • It is medically necessary.

Does Medicare cover non-emergency transportation?

Medicare Part B may pay for limited non-emergency ambulance transportation if your doctor writes an order stating it is medically necessary. For example, someone with End-Stage Renal Disease (ESRD) may qualify for payment of dialysis transportation under Medicare.

Medicare may also cover non-emergency transportation when a person is:

  • Unable to stand without assistance.
  • Not able to walk.
  • Unable to sit in a wheelchair or chair.
  • In need of vital medical services during a trip (this may include the monitoring of vital functions).

If an ambulance company provides non-emergency transport they believe Medicare won’t cover, they must give you an Advance Beneficiary Notice of Noncoverage (ABN). This document is to make you aware that you may have to pay for the services out of pocket.

Whether transport is for emergency or non-emergency care, the Medicare transportation benefit only covers ambulance services to the nearest appropriate medical facility that can give you the treatment you need. If you receive services that Medicare does not cover, you may have to pay some or all of the costs. If you are able, ask questions to understand why your doctor or an ambulance company is recommending transport to a nonlocal facility and whether Medicare will cover the charges.

Original Medicare transportation example

If Original Medicare is your sole coverage, your total out-of-pocket costs will include your monthly monthly Medicare Part B premium, your calendar year deductible and 20% coinsurance for approved services.

When calculating a claim payment, Medicare uses the Medicare approved amount — what Medicare will pay a doctor or supplier that accepts assignment — which may be less than the actual amount a provider charges. Assignment means a provider agrees to accept (or, by law, must accept) the Medicare-approved amount as payment in full. Most providers accept assignment, but it’s a good idea to check to be sure. If the provider does not accept assignment, you may be billed for the difference.

Below we have provided an example of how Original Medicare would pay for an ambulance bill:

Cost type
Amount
Ambulance bill total$1,500
Medicare-approved amount$1,000, of which Medicare paid 80%, or $800
Your out-of-pocket costThe remaining 20%, or $200

How a Medicare demonstration may impact non-emergency ambulance coverage

Demonstration projects allow the Centers for Medicare & Medicaid Services (CMS) to test and measure the likely effects of potential program changes, including new types of services and delivery methods, as well as new payment approaches.

Under one of these demonstrations, CMS is testing a Medicare prior authorization model for ambulance transport in eight states and the District of Columbia. If you live in one of these states and use non-emergency ambulance services regularly, you may need to take extra steps to submit your Medicare medical transportation charges for review:

  • Delaware
  • District of Columbia
  • Maryland
  • New Jersey
  • North Carolina
  • Pennsylvania
  • South Carolina
  • Virginia
  • West Virginia

This Medicare demonstration applies if you receive scheduled, non-emergency ambulance transportation at either of these frequency levels:

  • Three or more round trips in a 10-day period.
  • At least one trip per week for three weeks or more.

Under the demonstration, you or the ambulance company may send a request for prior authorization to Medicare before your fourth round trip in a 30-day period. This will let you and the company know earlier in the process if Medicare might cover your services.

If your prior authorization request is denied and you get the services anyway, Medicare will reject the claim and the ambulance company may bill you for all charges.

How do Original Medicare and a Medigap (Medicare Supplement) plan cover transportation?

Original Medicare and your Medigap plan work together to cover your Medicare-approved transportation costs.

Medigap plans are designed to supplement Original Medicare, meaning they "fill the gap" or address costs left over after Medicare pays. If Medicare rejects a transportation claim and your Medigap plan does not cover the service, then you would be responsible to pay the full amount for the ambulance.

When you receive services, present both your red, white and blue Medicare card and your Medigap identification card to your provider. Your provider then submits the charges to Medicare. If Medicare approves the service, they’ll cover their portion, then use an automated "crossover" system to notify your Medigap insurance company of the remaining charges (the gaps). You or your health care provider generally do not need to file a separate claim with your Medigap plan.

Original Medicare plus Medigap transportation example

After the cost of your Medicare Part B and Medigap premiums, your next out-of-pocket expense is the annual Part B deductible. Only Medigap plans C and F cover this cost, and only for current members — plans C and F are no longer offered to new enrollees.

Once you meet the Part B deductible, you are responsible for coinsurance of 20% of the Medicare-approved amount for medical services, including transport. Medigap plans cover coinsurance costs in full, with two exceptions: Plan K pays only 50% of your cost, and Plan L covers the cost at 75%.

Here is an example claim scenario. This example assumes your Medigap premium and your Medicare Part B premium and deductible are paid.
Cost type
Amount
Ambulance bill total$1,500
Medicare-approved amount$1,000, of which Medicare paid 80%, or $800
Your share of the costThe remaining 20%, or $200
Medigap Plan KPlan covers $100, and you pay $100
Medigap Plan LPlan covers $150, and you pay $50
All other Medigap plansPlan covers the full $200, and you pay $0

Do Medicare Advantage plans cover transportation?

Medicare Advantage transportation benefits are included in all Medicare Advantage plans, and they must be at least equal to what Original Medicare provides. However, many Medicare Advantage plans offer enhanced transportation benefits to help improve access to care.

For example, according to the Medical Transportation Access Coalition, your Medicare Advantage plan may partner with a specific transportation company, or a ride share service such as Lyft or Uber, to provide routine transportation services. At times, the benefit is offered along with a Silver Sneakers fitness program to help you get to your participating fitness center.

Because benefits and coverage levels vary by plan and location, there are no set Medicare Advantage transportation costs. Some plans require a copay, and others charge coinsurance for covered transportation services. And, some Medicare Advantage plans provide routine transportation benefits, while others cover only ambulance charges. If medical transportation will be a factor in choosing between a Medigap and a Medicare Advantage plan, it is important to research and understand the differences in coverage.

What if my medical transportation needs are not covered by insurance?

In the end, Medicare may not cover all transportation needs for seniors with Medicare. If you require access to routine medical transportation not allowed by your Medicare plan, you may qualify for help through organizations like those listed here. Contact the office nearest you for guidance.

  • Area Agency on Aging
  • Eldercare services
  • AARP
  • State Health Insurance Assistance Programs (SHIP)
  • Program of All-Inclusive Care for the Elderly (PACE)
  • Commercial options such as Uber Health or GoGoGrandparent

Editorial Note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.