Transportation plays a vital role in daily life, facilitating commutes, errands, and medical visits. However, with age, access to transportation often diminishes. A study revealed that around 25% of Medicare beneficiaries face limited transportation options. This article delves into Medicare’s coverage of medical transportation and provides additional resources for beneficiaries
Is transportation services covered by Medicare?
Original Medicare, consisting of Parts A and B, covers emergency ambulance transportation. However, nonemergency transport is usually not covered, except for certain cases. Medicare Part C (Medicare Advantage) plans, provided by private health insurance companies, may offer additional benefits not included in original Medicare, such as transportation to and from medical appointments. Let’s delve deeper into the specific types of transportation covered by Medicare.
What types of transportation are covered?
Emergency transportation:
Under Original Medicare, particularly Part B, ambulance transportation to the nearest suitable medical facility for emergency situations is covered. This coverage applies if:
- Medically necessary emergency services are required.
- Using another mode of transportation could jeopardize your health.
- In instances where ground transportation is insufficient for emergency treatment, Part B may cover transportation by helicopter or plane.
For emergency transportation, you are responsible for 20% of the cost after meeting the Part B deductible. Medicare Advantage plans offer similar emergency transportation coverage, though specific rules may vary.
Nonemergency transportation:
Medicare Part B may cover nonemergency ambulance transportation with a doctor’s note stating medical necessity. Before transport, the ambulance company might issue an Advance Beneficiary Notice of Noncoverage (ABN) if they doubt Medicare will cover the trip. You must decide whether to proceed with the service if presented with an ABN; if Medicare doesn’t cover it, you may be liable for the entire cost.
Medicare Advantage plans may cover nonemergency transportation to approved locations like doctor’s offices or clinics, but coverage specifics depend on your plan. Due to potential variations in rules, it’s essential to review your plan for inclusion details.
What alternative transportation choices exist?
Beyond Medicare’s covered services, you may have additional options:
Medicaid:
This joint federal and state program aids individuals with lower incomes in paying healthcare expenses. Alongside covering emergency ambulance transportation, Medicaid can fund nonemergency transport to medical facilities. In 2015 alone, an estimated 59 million outpatient trips utilized this service. Eligibility for nonemergency transport may require certain conditions, such as lacking a car or driver’s license, having a disability, or being unable to travel independently.
Programs of All-Inclusive Care for the Elderly (PACE):
PACE, a Medicare and Medicaid joint effort, delivers coordinated care by a professional team. Eligibility criteria include age 55 or older, residence in a PACE-covered area, needing nursing home-level care, and the ability to safely reside in the community with PACE assistance. PACE covers all medically necessary services under Medicare and Medicaid, including transportation to PACE centers and local doctor appointments.
State and local programs:
Various state or city programs may offer transportation assistance, with services differing by location. Area Agencies on Aging (AAA) are particularly helpful for individuals aged 60 and over, emphasizing transportation access. The Eldercare Locator, an Administration on Aging tool, aids in locating state and local programs, including AAA, to address diverse needs in your area.
Conclusion:
Medicare provides coverage for certain transportation needs related to medical services, encompassing both emergency and nonemergency situations.
Emergency ambulance transportation is covered by both original Medicare and Medicare Advantage. However, nonemergency situations are generally not covered under original Medicare unless pre-approved, while some Medicare Advantage plans may include this as an added benefit.
Additional resources such as Medicaid, PACE, and state or local programs offer alternative transportation options. The services offered and eligibility criteria for these resources vary depending on your location.