Understanding Medicare Transportation Benefits

Medicare in Motion

There’s an apocryphal story circulating around the internet about a woman who called 911 complaining of chest pains. When paramedics arrived, she revealed she was fine: she merely wanted a ride to the hospital for a routine appointment. It’s a tale of entitlement and egregious abuse of the medical system. Regardless of whether or not it happened, there is an underlying truth: most people have no idea how to travel to medical appointments when they lack transportation. 

If you didn’t have your own car, how would you go to the hospital? Calling an ambulance is OK for an emergency, but elective surgery? Public transportation is an option, but not in rural areas. You could rely on friends or family, but many seniors live far from relatives, and work schedules can conflict with medical appointments. 

While Medicare transportation is limited to emergencies under Part B, other services offer a variety of transportation benefits: some of which might be unexpected.

Medicare Transportation Services Under Part B

Medicare medical transportation falls under Part B, the medical insurance portion of Medicare. These benefits do not fall under Part A, which is exclusively the hospital insurance portion of Medicare.

To qualify for Medicare ambulance coverage, you’ll need to either:

1. Be experiencing a medical emergency that requires the use of an ambulance. This covers most situations where you or a loved one would call 911 to dispatch an ambulance.
2. You need transportation to a medical facility, but traveling in another vehicle could put your health at risk. This often overlaps with a medical emergency, but can also apply to people who need life-sustaining medical equipment or active medical care that cannot be transported in an ordinary vehicle.

If you are not experiencing an emergency, you will need a doctor’s approval to use an ambulance, and Medicare may not cover it. 

Medicare also covers medical evacuation services from locations an ambulance cannot reasonably reach. In these cases, a plane or helicopter will be dispatched instead. 

Like most services under Original Medicare, you’ll be required to pay 20 percent of the cost after meeting your deductible, with no out-of-pocket maximum. 

Still, there are many transportation services that Original Medicare won’t cover, like the humble ambulette. 

You might also know them as medical shuttles or accessible vans: these vehicles are for transporting disabled and convalescent patients who are not in immediate danger. While there are dedicated ambulette services, an ambulance can be temporarily converted to an ambulette by turning off the sirens. It’s a bit of semantic trickery that can turn a safe ride home into a massive bill if you’re unprepared for it. 

Luckily, ambulance and ambulette providers must inform you if they believe Medicare will not cover your services, presenting an estimated price. This is unlikely to come up in a genuine emergency, but something to keep in mind when the time comes to return home.

Luckily, there are other ways of getting where you need to go.

Stateside Solutions

If you qualify for Medicaid, you may also qualify for non-emergency transportation services, such as ambulettes. This only applies if you’re unable to drive in the long term: that means no driver’s license, no car, a disability that prevents you from getting one or both of those things, and circumstances that prevent you from waiting for a friend or public transportation. The exact rules vary by state, but they can help. 

Another option, which does not require Medicaid enrollment, is the Programs of All-Inclusive Care for the Elderly (PACE). These programs are aimed at seniors who need nursing home levels of care. Though PACE is not available in every community, they can be a massive boon for those who qualify.

If neither of these solutions works for you, you can seek out local organizations in your area. Many have volunteers able to transport you to an appointment, and some even keep ambulettes and shuttles at the ready. 

But what if none of those options work for you? What are you supposed to do, call an Uber?

Surprisingly, yes. You can, in fact, do just that.

Uber, Lyft, and other ridesharing and taxi services now offer non-emergency medical transportation through private insurers. With the right Medicare Advantage plan, you literally can Uber to your appointment and charge it to your insurance. You don’t even need to download the app in many cases. 

Medicare Advantage, also known as Medicare Part C, is an expanded version of Medicare offered by private insurers. They have all the same benefits as Original Medicare, including ambulance coverage. However, they may also offer additional perks to incentivize enrollment. 

One such benefit is Medicare non-emergency transportation benefits. Traditionally this is done through medical shuttle and ambulette services. Still, the widespread adoption of Uber and Lyft means that a growing number of plans are partnering with the ridesharing giants.

These benefits are not universal, however. While all Medicare Advantage plans have the same essential benefits as Original Medicare, the additional benefits may vary depending on your area and the plan in question. Some plans may not offer transportation benefits, while others may only offer transportation benefits instead of other options like dental or vision care. Be sure to check with your provider to see what benefits are offered by your specific plan.

If you don’t yet have a Medicare Advantage plan, it’s never too early to start your research. Annual enrollment begins October 15th, but exceptional circumstances like moving or recently turning 65 may qualify you to apply sooner.