Medicare, Medicaid, and Non-Emergency Medical Transportation
Does Medicare Pay for Non-Emergency Medical Transportation?
Non-emergency medical transportation is not typically covered under Medicare Plans Part A and Part B. However, some Medicare Advantage plans may cover transportation to doctor appointments. Patients may also be able to get non-Medicare transportation to doctor appointments through various organizations such as Area Agency on Aging.
Medicare Part B does cover ground ambulance transportation when traveling in another vehicle could endanger the health of the patient and, thus, renders a medical necessity when traveling to/from the following:
- Hospital
- Critical access hospital
- Skilled nursing facility
Medicare can pay for emergency ambulance transportation in an airplane or helicopter if the patient needs immediate and rapid transport that ground transportation can’t provide. Some cases may have Medicare pay for limited, medically necessary, non-emergency ambulance transportation if the patient has a written order from a doctor stating that the transportation is a medical necessity. After meeting the Medicare Part B deductible, the patient is responsible for paying 20% of the Medicare-Approved Amount.
Additionally, it is important to note that Medicare will only cover ambulance services to the nearest appropriate medical facility that’s able to give you the care you need.
Does Medicaid cover Non-Emergency Medical Transportation?
Medicaid does cover the cost of non-emergency medical transportation for eligible patients and recipients. Medicaid-approved transports are strictly non-emergency and include transportation to/from hospitals, doctor offices, physical therapy, treatments centers, dialysis clinics, and more.
Medicaid may cover patient transportation to medical appointments if:
- The patient doesn’t have a working vehicle or a driver’s license.
- It’s not safe for the patient to drive or wait for a ride to a doctor appointment because of a health condition, physical disability, or mental disability.
- The patient has no other reasonable means of getting to the doctor.
It is up to each state-run Medicaid program to decide the most appropriate means of transportation.
What other non-Medicare transportation options might be available?
Patients eligible for the Program of All-Inclusive Care for the Elderly (PACE) may also receive transportation for routine medical care along with some Medicare Advantage plans and Special Needs Plans (SNPs) serving high-need populations.
As of 2022, around 38 percent of Medicare Advantage plans and 87 percent of Special Needs Plans authorized innovative benefits which, in some instances, include transportation assistance that transition Medicare does not cover.