Non emergency medical transportation covered by medicare

Just the Essentials...

• Medicare Part B covers emergency transportation.

• Medicare only covers air transportation if the urgency of the patient’s health condition demanded transport faster than an ambulance.

• Non-emergency transportation requires a physician’s letter stating medical necessity for the patient.

• If a patient demands a specific emergency facility when another one is closer, Medicare’s reimbursement may differ which can mean extra costs.

Does Medicare pay for transportation? When is transportation covered by Medicare?

So, does Medicare cover medical transportation? In certain situations, some Medicare transportation provider costs to medical facilities will be covered. Typically, coverage applies if the transportation costs resulted from health care needs.

In general, for Medicare to cover transportation services:

1. A doctor must determine it medically necessary
2. Ambulance company accepts Medicare assignment
3. The facility transported to should accept Medicare assignment

When it comes to Original Medicare (Parts A and B only), Medicare covers about 80 percent of costs for ambulance rides that a doctor deems medically necessary.

For those with a private Medicare health plan, like a Medicare Advantage plan, covered Medicare transportation providers must meet or exceed the coverage provided by Original Medicare. In many cases, a plan exceeds Medicare’s transportation coverage.

To find and compare Medicare transportation coverage offered by Medicare health plans in your area, enter your zip code to begin a zero-cost custom quote.

Which Part of Medicare Covers Transportation?

In order for Medicare to cover any transportation services, you must at least have Medicare Part B. Patients with only Medicare Part A do not qualify for transportation benefits.

Many Medicare health plans include transportation. As a rule, plans all must cover the same transportation services as Medicare, but many plans offer even greater transportation benefits.

By the time Medicare provides your health insurance, your needs for mobility and independence may have already surfaced. With that in mind, the transportation needs of some can sometimes exceed that of a typical ambulance.

But what about Medicare non-emergency transportation? Does Medicare cover transportation to medical appointments? Let’s learn more.

What types of transportation will Medicare cover?

The kind of transportation Medicare will cover depends on the patient’s condition and, just as importantly, their location.

In a medical emergency, ambulance transportation for Medicare patients is covered to the very closest appropriate medical facility.

If a patient is experiencing a life-threatening emergency and an airlift is needed, Medicare may cover the service if any other method of transport poses danger.

But what about non-emergency transportation? Does Medicare pay for transportation to doctor appointments? Well, in some situations, Medicare can cover non-emergency ambulance transportation.  However, it is harder to approve Medicare non-emergency transportation than emergency Medicare medical transportation.

Whenever an ambulance company provides non-emergency transportation, and believes Medicare may not pay for it, they must give you an Advance Beneficiary Notice of Noncoverage (ABN).

Essentially, an ABN is a document you sign that acknowledges that Medicare will likely deny coverage for the service received. However, the ABN must be presented by the Medicare provider, like an ambulance company, before rendering the service.  Otherwise, without first receiving an Advance Beneficiary Notice of Noncoverage, then you may not have to pay if Medicare denies coverage.

When will Medicare cover ambulance transportation?

A patient with Medicare Part B may have ambulance services covered if transportation is to or from a hospital. Patients in a skilled nursing facility (SNF), or critical access hospital (CAH) may also qualify for eligible services. Medicare covers ambulance services if transport by any other means would endanger a patient’s health.

Whether transportation is medically appropriate is the responsibility of Medicare claim reviewers. These claims analysts use information on the insurance claim, and refers to similar claims when determining eligibility for transportation services.

Examples of medical emergencies that warrant emergency ambulance transportation for Medicare patients include:

• Uncontrolled, heavy bleeding
• Shock
• Unconsciousness
• Altered mental state
• Skilled care during transportation

Although far from exhaustive, the list above gives examples of common conditions. Medicare ambulance transportation coverage applies with transport to the nearest medical facility. Moreover, the facility must be able to provide the care the patient needs.

If a patient demands to choose a facility other than the nearest one, Medicare’s ambulance reimbursement payment could differ, resulting in larger out-of-pocket costs.

If the patient demands transport to a facility located further away than the nearest appropriate facility, Medicare adjusts the cost to the patient. In short, most ambulance companies charge by distance, meaning the difference in charges could be large.

The beneficiary will be responsible for the difference. In rare cases where there is no appropriate facility nearby, Medicare will pay for transportation charges to a non-local facility.

When will Medicare cover air transportation?

An alternative to ambulance transportation is transport by air. Medicare medical transportation in a helicopter or airplane may be covered if a patient’s health condition requires such travel. Travel by air must be deemed faster than an ambulance to be considered for coverage.

Additionally, Medicare-covered air transportation demands that any delay in treatment could result in loss of life or serious complications. Example scenarios that may qualify a patient for air travel rather than a traditional ambulance include:

• A pickup location difficult to reach by ground transportation
• Long distances to nearest facility (especial in a rural area)
• Heavy traffic that could prolong sensitive transportation times

When will Medicare cover non-emergency transportation?

In a few instances, Medicare Part B will cover non-emergency medical transportation. Medicare covers this type of transportation is covered if a doctor determines that any other transportation could endanger the patient’s health.

In order to receive Medicare rides to doctor appointments, a patient would need a written order from a physician.

The order would have to medically state the need for ambulance transportation, even though the patient is not having an emergency medical episode.

Doctors often order Medicare non-emergency ambulance transportation for patients with end-stage renal disease. End-stage patients are medically vulnerable and need rides to dialysis treatment facilities, sometimes daily. Transportation to and from a dialysis center may be dangerous for the patient compared to any other type of transportation.

Non-emergency ambulance transport may be covered under Part B Medicare if a patient falls under certain criteria:

• Transportation to a patient’s home after hospital discharge
• Patients residing full-time in a nursing home needing transportation for non-emergency doctor’s office
• Transportation for a patient arriving or returning to a nursing facility
• Rides to and from dialysis facilities for treatment

What about Medicare Advantage plans with transportation coverage?

If you are familiar with your Medicare options, you may have heard that the dream of getting your medical transportation covered by Medicare may be a reality under certain Medicare Advantage plans. Believe it or not, it may be possible to get transportation services insurance through certain Medicare Advantage plans, including non-emergency Medicare appointment transportation.

Keep in mind, however, that Medicare Advantage plans are offered by private insurance providers. This means that exact pricing, availability, and benefits (including any Medicare Advantage transportation benefit or non-emergency Medicare transportation to medical appointments) will vary from plan to plan. Remember that Medicare Advantage plans with transportation coverage may not be available everywhere.

What’s the Medicare beneficiaries’ cost associated with transportation?

So, does Medicare offer transportation? Well, now you know that Medicare has a set amount they will approve for patient transport. Transportation services that are part of Medicare’s network are required to accept Medicare’s agreed amount.

Patients with Medicare Part B will be responsible for 20% of the Medicare-approved charge. Meanwhile, Medicare pays the other 80%.

If the ambulance company accepts assignment from Medicare, then it must instead accept an agreed-upon payment when transporting Medicare beneficiaries. Often, the Medicare-approved amount paid to the provider is less than the amount normally charged.

For example, if ambulance transportation took place due to a serious medical emergency, an ambulance company might normally charge $800. Hypothetically, let’s say the Medicare-approved amount is $400. Instead of paying 20% of $800, a Medicare beneficiary pays 20% of only the $400 Medicare-approved fee, amounting to $80.

The difference in charges is because patients are only responsible for 20% of the Medicare-approved amount.

However, a few situations demand different charges for transportation:

• If a patient has not met their Medicare Part B deductible, they must pay it as well as the 20%
• Patients at a Critical Access Hospital (CAH) who receive transportation via a CAH-owned ambulance may pay less
• Transport demanded to a facility further away than the closest appropriate facility can incur greater charges from the ambulance provider than 20% of the Medicare-approved amount

The balance remaining after Medicare paid is eligible for secondary insurance, which may come in the form of a Medicare Advantage Plan or a Medigap supplemental plan.

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