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Original Medicare pays for ambulance services for emergencies and for some approved situations that are not emergencies, but its coverage pretty much ends there.
Some private Medicare Advantage plans cover emergency ambulance services as well as transportation to doctor’s appointments and some transportation beyond that for people with chronic conditions. The benefits vary significantly from plan to plan.
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What transportation costs does Medicare pay for?
Medicare covers emergency ambulance transportation if you require medically necessary services at a hospital or skilled nursing facility and you can’t be safely moved otherwise. It may allow emergency ambulance transportation via plane or helicopter if you can’t get care fast enough using ground transportation.
Medicare covers an ambulance ride that’s not an emergency if your doctor writes an order stating that an ambulance is medically necessary because other ways to get you to an appointment could endanger your health. For example, if you’ve been diagnosed with end-stage renal disease, Medicare may pay if you have a doctor’s order stating that it is medically necessary for you to use an ambulance to take you to and from a dialysis center. You may need prior authorization beforehand.
These services usually are paid for through Medicare Part B, which requires a 20 percent copayment of the Medicare-approved amount after you pay the annual deductible, which is $240 in 2024. A Medigap plan can help cover the copayment.
Does Medicare Advantage cover transportation?
Medicare Advantage plans issued through private insurers cover emergency ambulance services. But they may have different copays, such as $245 per trip for one plan while another may cost $260. They may allow some nonemergency ambulance services if you receive prior authorization.
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Does Medicare cover this?
These plans may pay for transportation to doctor’s appointments and even nonmedical transportation for people with certain chronic conditions.
Medical-related transportation. In 2024, 36 percent of regular Medicare Advantage plans and 88 percent of Medicare Advantage special needs plans provide transportation benefits for medical needs, according to KFF, a health policy nonprofit formerly known as the Kaiser Family Foundation.
For example, you may have a $0 copay for up to 36 one-way trips every 12 months to approved health-related locations, such as doctor appointments. You may need to use a transportation vendor that the plan has approved.
Nonmedical transportation. People with chronic conditions may qualify for additional transportation benefits. Medicare Advantage plans have been able to offer Special Supplemental Benefits for the Chronically Ill since 2020. Not necessarily medically related, these extra benefits can include expenses such as a grocery allowance, home modifications, meal delivery and pest control. Each plan determines which chronic conditions qualify.
Some may include transportation for needs that aren’t medical. In 2024, 6.1 percent of regular Medicare Advantage plans and 29.8 percent of special needs plans provide nonmedical transportation benefits for people with certain chronic conditions, according to KFF.
For example, a plan may cover up to 24 one-way trips every 12 months with a $0 copay for members with qualifying chronic conditions to go to plan-approved, nonmedical locations such as churches, community events, grocery stores and senior centers. Authorization may be required for trips of more than 50 miles.
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