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Does Medicare Cover Transportation to Medical Appointments?

Part B of Original Medicare covers emergency transportation services if you are experiencing a medical emergency that requires services at a hospital or skilled nursing facility. However, this service is only available for nonemergency scenarios in rare situations, such as when a beneficiary with End-Stage Renal Disease requires passage by ambulance to a dialysis facility. 

If you qualify for Medicare transportation coverage, you will have to pay 20% of the Medicare-approved amount for your transport. You may also be liable for the difference if the cost of your ride exceeds the Medicare-approved amount. If you need nonemergency medical transportation covered, you might have better luck with commercial providers or other government-backed healthcare programs.

The Growing Need for Transit in Senior Communities

Transportation is an especially critical need among seniors, many of whom cannot transport themselves. Each year, over 600,000 people over 70 stop driving, becoming dependent on others to get around. This is evident in another recent study that showed that 80% of caregivers provide transportation to people in their care.

The reliance on caregivers for rides underscores the pressing need for accessible and reliable solutions tailored to seniors. With an increasing number of older adults relinquishing their driving privileges, it becomes crucial for members to access transit that keeps them safe while connecting them with family, friends, and medical providers.

How Does Medicare Covered Transportation Work?

If you require emergency transportation to a medical facility, Original Medicare will cover the costs under its medical insurance component. Medicare may also cover medically necessary nonemergency transit in specific circumstances.

Eligibility For Medicare Transportation

Original Medicare covers emergency transportation if you require medically necessary emergency services to a hospital, skilled nursing facility, or critical access hospital. Medicare coverage applies in scenarios where you would face an increased health risk by seeking transport in a nonemergency vehicle.

Medicare considers a situation an emergency when it meets one or more of the following criteria:

  • A person is set to receive a service covered by Medicare.
  • A person is traveling within the coverage guidelines set by Medicare.
  • A person is unconscious or in shock or losing lots of blood.
  • A person’s health is at severe risk.
  • A sudden medical crisis has occurred.
  • Emergency services are required for the necessary transportation.
  • The ambulance satisfies the requirements set by Medicare.
  • The services are medically necessary.

Nonemergency Scenarios Where Medicare Covers Transportation

Original Medicare transportation benefits cover nonemergency services in rare situations, and coverage only applies if you are being transported by ambulance to a clinic or doctor’s office approved by your plan. To receive coverage, you need a doctor’s note verifying that a nonemergency ambulance ride is medically necessary. However, Medicare Part B does not cover other types of nonemergency transit, such as passage to medical appointments.

If you seek medically necessary nonemergency transportation in an ambulance, you might receive an Advanced Beneficiary Notice of Noncoverage (ABN) even if you have a doctor’s note. An ABN indicates that your plan may not cover the requested ambulance ride. After receiving an ABN, you can either agree to the ABN or decline the ambulance service. If you agree to the ABN and your Medicare plan does not cover the services, you will be liable for the whole cost.

Medicare Supplement and Transportation

Medigap is supplemental insurance that covers some of the expenses Original Medicare does not pay for. Medigap does not cover transportation services directly, but it can pay for your Part B plan’s deductible or the 20% coinsurance owed for emergency transport after Original Medicare does its part.

Medicare Demonstrations and Part B Coverage

Through Medicare’s demonstration projects, the Centers for Medicare & Medicaid Services (CMS) test possible program changes and evaluate their impacts.

In Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, West Virginia, and Washington, D.C., CMS is using a demonstration to test a model where beneficiaries must seek pre-authorization for frequent nonemergency ambulance rides covered by Medicare Part B.

If you live in one of the states mentioned above or the District of Columbia, you might need to jump through some extra hoops to get certain nonemergency transportation services covered.

Does Medicare Advantage Cover Transportation?

Medicare Advantage plans offer the same benefits as Original Medicare, meaning your Medicare Advantage plan should cover transportation just as Medicare Part B would. In other words, any Medicare Advantage plan provides coverage of medically necessary emergency transportation and may cover medically necessary nonemergency transportation in rare circumstances.

Some types of Medicare Advantage plans may also cover additional nonemergency ride services for a low or $0 copay. Lyft, a rideshare company, partners with certain Medicare Advantage plans to provide nonemergency passage to healthcare facilities like clinics, pharmacies, and doctor’s offices. Lyft may even offer passage to fitness centers in collaboration with some Medicare Advantage plans.

How Much Does Medicare Transportation Cost?

After receiving Medicare coverage, you will still be liable for 20% of the Medicare-approved amount for your transit services. The average ambulance ride costs $1,277, meaning you would be liable for about $255 after insurance. That said, the exact amount you’ll owe depends on your Medicare plan and any other insurance you might have. In cases where Original Medicare covers nonemergency transportation, the same terms apply: Medicare covers 80% of the Medicare-approved amount, and you’re responsible for the rest.

You must also pay your annual deductible for Medicare Part B, which amounts to $226 in 2023. And if your emergency ride services cost more than the Medicare-approved amount, you may also have to pay for the difference.

How To Get Your Transportation Covered

You must adhere to the following steps to ensure that Medicare covers your eligible transportation services:

  1. Make sure your Medicare plan’s benefits cover your transit services.
  2. If possible, have your doctor order the ride for you.
  3. If you are seeking nonemergency transportation, call your plan carrier to see whether the these services might be eligible for coverage.
  4. Consult your doctor for a letter of medical necessity regarding your transportation services.

Non-Medicare Transportation Options for Seniors

Other options are available if you require medical ground transit that your Medicare plan does not cover. Read on to learn how to secure affordable ride services.

Medicaid

Medicaid helps lower income individuals cover healthcare expenses. Like Medicare, this joint state and federal program pays for emergency transit services. It also pays for nonemergency rides to clinics and doctor’s offices via car, bus, taxi, or van.

This coverage applies to beneficiaries who cannot drive themselves and have no other reasonable way to get to the healthcare facility they need. If you do not have a car or driver’s license, have a disability, or cannot travel alone, you may be eligible for nonemergency transportation coverage through Medicaid. Each state manages its own Medicaid program, so consult with your state’s Medicaid office for details about coverage.

PACE

Medicare and Medicaid jointly run Programs of All-Inclusive Care for the Elderly, or PACE. You might qualify for PACE if you meet the following standards:

  • You have Medicare and/or Medicaid.
  • You are 55 or older.
  • You live in a PACE-covered area.
  • You require care that is usually administered in a nursing home.
  • With PACE assistance, you can live in your community safely.

PACE covers rides to PACE centers for medically necessary services. It may also cover rides to a doctor’s office in your community. As a PACE beneficiary, you can expect to pay a monthly premium but will not be liable for deductibles or copays.

Private Options

Some commercial providers offer low-cost medical transportation services, and rideshare apps are some of the most popular options among people turning to private transportation providers.

Lyft Healthcare allows eligible users to order rides to fitness appointments, doctor’s offices, pharmacies, and other qualifying facilities for a reduced price. Similarly, Uber Health lets seniors book rides to medical appointments without downloading the Uber app. Uber Health also allows loved ones to book rides for the seniors in their lives.

GoGo is another popular private provider. With just a phone call, GoGo coordinates rides, meal and medication deliveries, and home chores for seniors using platforms like Instacart, DoorDash, and Uber. Though not available everywhere, GoGo provides services in dozens of major cities across the United States.

Local Options

You might also be able to find nonemergency transportation programs in your local area. Start by checking with the Administration for Community Living (ACL), which may be able to connect you with community-based services for older people and people with disabilities in your area. 

ACL also partners with Eldercare Locator, which provides an online tool that allows you to search for services based on ZIP code. You can also call Eldercare Locator at 1-800-677-1116 or find services via online chat.

The National Volunteer Transportation Center helps older people connect with free rides through volunteer or shared-ride programs in their area. And the National Aging and Disability Transportation Center conducts individual phone consultations to set up seniors with local low-cost transit services.

Putting It All Together

Low-cost transportation is a vital need among seniors and people with disabilities, especially when they cannot safely transport themselves. Original Medicare and Medicare Advantage do cover medically necessary emergency transportation services, and some Medicare Advantage plans also pay for nonemergency medical transportation to facilities like doctor’s offices and pharmacies. However, if your Medicare plan does not cover nonemergency transit, you might be able to find low-cost programs through rideshare services like Lyft and Uber or other private providers.

However, the need for transportation stretches beyond medical care, as many people require rides to fitness centers and daily necessities. Local and regional assistance programs often provide affordable options for people who need transportation services to live independently.

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