Medicare typically does not pay the cost of non-emergency medical transportation (NEMT) unless it occurs under specific circumstances. Those circumstances involve a doctor declaring in writing in that the trip is medically necessary and a healthcare company that participates in Medicare providing the transportation.
For those interested in whether Medicare pays for NEMT, it’s important to understand the details of the rules. Since most people who use NEMT do not qualify for Medicare coverage, many people choose to instead purchase medical travel insurance.
When Does Medicare Cover Non-Emergency Medical Transportation?
Medicare Part A and Medicare Part B typically do not cover NEMT for patients to or from home. Medicare Part B may cover NEMT transportation between home and a hospital, or to another place where a person receives medical treatment or diagnosis. However, coverage requires a written certification from a doctor that the transportation was necessary to protect the patient’s health.
It’s important to note that even with a doctor certifying the trip as medically necessary, coverage is not guaranteed. The only way to be 100% sure that you will get the cost of NEMT covered in this situation is to get the doctor’s office to receive approval in advance from Medicare. Otherwise, it’s possible that a patient could have responsibility for the full cost of the trip.
That’s important to know because of the large amounts sometimes involved with medical transport costs.
Potential NEMT Payments With Medicare Part C
Medicare Part C, or a Medicare Advantage Plan, is an option that some people choose to get Medicare benefits through a private health insurer. These plans cover whatever is included in Medicare Part A and Part B. However, in some cases, they cover more, including non-emergency medical transportation.
To find out whether that is the case with your Medicare Advantage Plan, you must contact the health insurance provider directly. Even if Medicare pays, the payments typically are capped at 80% of transportation costs.
Any chance for getting Medicare coverage will mean that the transportation meets two basic criteria.
First, the care must meet the standard for “medically necessary.” Typically, this means a physician or authorized medical provider must certify in writing that the transportation is necessary. Second, a healthcare provider who participates in Medicare must provide the transportation.
Medicare specifies that it “may” pay for “limited, medically necessary, non-emergency ambulance transportation” with a written order from a doctor. They add: “For example, someone with End-Stage Renal Disease may need medically necessary ambulance transport to a facility that furnishes renal dialysis.”
However, they also note that a health care provider may recommend services more often than Medicare covers, or recommend services Medicare does not cover. The bottom line for those who want to know if Medicare pays for NEMT is to ask questions of your doctor and, if applicable, your third-party insurance provider to find out if you are eligible for coverage. That will keep you from getting stuck with a high bill for transportation and allow you to use NEMT when it is really needed.