Getting to and from medical appointments can be a challenge for seniors. If you need transportation for healthcare services, you may be questioning if Medicare covers the cost. The answer is that it depends on the type of Medicare plan you have, the destination healthcare facility, the medical necessity and whether or not the situation warrants emergency transport.
Transportation to see the doctor
Original Medicare does not cover your ride to doctor appointments, but some Medicare Advantage (MA) plans include this transportation benefit. At minimum, MA plans have to cover their members for benefits provided by Original Medicare, and many MA plans go beyond this coverage to offer extra benefits.
Transportation is an extra benefit for some MA plans, along with over-the-counter drugs, fitness programs, vision services, dental care, hearing, and more. The Medicare Advantage transportation benefit is different from ambulance services.
How does Medicare cover ambulance services?
Original Medicare covers the cost of an ambulance only if the transportation is medically necessary and falls into one of the following scenarios:
- You need ground ambulance transportation to get to a hospital, critical access hospital (a facility in a rural area) or skilled nursing facility (SNF) because any other conveyance may jeopardize your health.
- You need to get to the hospital via medical flight (air transportation, such as a plane or helicopter) due to an urgency that rules out ground transportation as a viable option.
- You have a medical need, but not an emergency, for ambulance transportation as documented by your doctor. Medicare uses the example of a patient with end-stage renal disease (ESRD) who needs to be taken to a facility for renal dialysis.
How does Medicare cover ambulance services to a distant facility for non-emergencies? Medicare covers transportation by ambulance only as far as the nearest facility appropriate for the delivery of services. Ambulance services fall under Part B, requiring an out-of-pocket expense for the Part B deductible ($233 in 2022) and 20% coinsurance.
Medicaid coverage for transportation
If you are dual-eligible for both Medicare and Medicaid, you may have additional benefits. In addition to emergency medical transportation for immediate medical attention, Medicaid covers round-trip transportation for doctor appointments at medical offices and hospitals if services rendered are Medicaid-approved. This type of service is known as non-emergency medical transportation (NEMT). You may qualify for NEMT if you have Medicaid coverage and one of the following situations:
- You do not have a car, or your vehicle is not working.
- Your driver’s license, if you have one, is not current.
- You have a disability (physical or mental).
- You are not capable of traveling alone or waiting alone for a lift.
According to federal regulations, Medicaid recipients are eligible for round-trip transportation for medically necessary medical appointments, but states individually define “medically necessary.” If you have Medicaid, check your state agency for rules in your area.