Is Non-Emergency Medical Transportation Covered by Medicare?

Non-emergency medical transportation (NEMT) benefits people who require assistance to get to their medical appointments. NEMT vehicles are equipped to accommodate the needs of persons with disabilities, the elderly, and wheelchairs. Non-emergency transportation can include visiting the doctor, getting groceries, or commuting to work.

Medicare doesn’t typically cover non-emergency transportation. However, it does cover specific types of medical transportation. Medicare consists of Part A and Part B, covering emergency transportation. The offers of Medicare Part C are from private health insurance companies in contact with Medicare.

Medicare offers broad coverage of services like laboratory tests, consultations, surgeries, wheelchairs, walkers, and necessary items to treat your condition. Some factors influence Medicare coverage. They include the following:

Local Coverage Determinations

Every state has local companies that process Medicare claims. The companies decide on what services or items are medically necessary to receive coverage under the Medicare laws in that particular state.

National Coverage Determinations

Medicare decided the services and items to cover on a national level.

The Law

There are federal laws or state laws that describe Medicare benefits. Medicare adheres to the said laws when offering a particular service or item.

When Does Medicare Cover Non-Emergency Medical Transportation?

Medicare Part A and Medicare Part B don’t cover NEMT for patients, irrespective of whether they are coming or leaving home. With a written certification from the doctor, Medicare Part B patients may receive NEMT transportation from home to the hospital and back. If the doctor indicates that transportation is necessary to protect the patient’s health, you can get a ride to your appointment.

Even with the doctor’s certification, there is no guarantee you will receive transportation coverage. To ascertain you will receive the coverage 100% is by the doctor’s office gets approval in advance from Medicare.

You can choose the Medicare Part C option, whereby you receive Medicare benefits through private health insurance. Part C cover includes the standard coverage offered for Part A and B, including non-emergency medical transportation.

You should contact your health insurance provider and determine if your Medicare Advantage Plan offers NEMT services. For Medicare to cover NEMT, the transportation must meet two main criteria:

First, it should be medically necessary, which means that a physician certifies by writing that the transportation is necessary. A good example is a case where someone has End-Stage Renal Disease and requires transportation to get to the renal dialysis unit.
Second, transportation is provided by a healthcare provider who is a part of Medicare.

There are instances when your physician will recommend more services that Medicare covers. Under such situations, consult the doctor on the necessity of the services, as you will have to cover the bill yourself. The charges will depend on the following things:

Other third-party insurance you have
The type of facility
Doctor’s charges
Where to get the test, service, or item
If your doctor accepts the assignment

Ask your doctor if you want to determine if Medicare pays for your non-emergency coverage transportation services. You may be qualified for the services or are eligible for the services via a third-party insurance provider. Knowing your stand will prevent you from getting stuck with a high transportation bill, and you can request the NEMT when needed.

What Types of Transportation Does Medicare Cover?

Medicare covers two types of transportation. They include the following:

Non-emergency Transportation

To receive non-emergency transportation in an ambulance, the ambulance company may give you an Advance Beneficiary Notice of Noncoverage (ABN) before the trip. An ABN is sent under the following conditions:

When the ambulance company is uncertain whether Medicare will pay for the trip
When you request a ride in a non-emergency situation

After receiving ABN, it’s up to you to decide whether you require the service. In addition, you should be ready to foot the bill if Medicare chooses not to cover it.

Medicare Advantage plans may cover the NEMT to your appointment if your plan approves the location. It is best if you know what your plan entails.

Your plan may be affected by the Medicare demonstration program if:

You get transportation from any ambulance company nationwide.
You schedule a NEMT more than thrice in ten days or at least once a week for a month or more.

Under the demonstration, your ambulance company can request prior authorization from Medicare and find out in advance whether Medicare will cover the services. If Medicare denies the claim and you continue accessing the ambulance services, you will pay the bill.

Emergency Transportation

Medicare covers emergencies if it meets the following criteria:

If transportation is another vehicle, it increases the risk to your health.
If you are in dire need of emergency services.

In cases where ground transportation isn’t practical, you can be airlifted by helicopter or plane. After the Part B deductibles, you’ll pay 20% of the cost in emergency cases.

What Are Other Transportation Options Available?

Apart from Medicare, other transportation options can cover you if:

Don’t have a car
Are mentally or physically disabled
Can’t travel or take a ride alone
You don’t have a valid driver’s license

Some of the companies you can contact when in need of transportation services include the following:

Medicaid
Uber Health
SilverRide
GoGoGrandparents
Programs of All-inclusive Care for the Elderly (PACE)

Reach Us

If you require non-emergency transportation and don’t know where to seek the services, we got you. At Around the Sound, we provide the best transportation to persons with gurneys, wheelchairs, or scooters. Our services stretch to people with disabilities, special needs, the elderly, and those with memory issues.

Our vehicles are equipped to meet your needs. We provide both long and short-distance transportation to the destination of your choice. Our drivers are skilled and with an unbeatable track record in time management, passenger safety, and satisfaction. Don’t miss out on any events and get-togethers. Trust us to meet every unique need you may have. Call us at (253) 858-7088 or message us online today. We are open every 24 hours a day, seven days a week.

Categorised in: blog, Medical Transportation, Medical Transportation Service, Non-Emergency

This post was written by Around The Sound