Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
You may need transportation to and from a hospital or other care facility, including your doctor’s office. Original Medicare only covers ambulance transportation deemed medically necessary and when your medical condition is such that traveling any other way would endanger your health.
Medicare Advantage (MA) Plans also cover medically necessary ambulance transportation as a Medicare-covered service. MA plans may help pay for transportation that Medicare does not cover.
According to the Kaiser Family Foundation (KFF), in 2021, 36% of the Medicare Advantage plans available across the country include transportation as an additional benefit. Chances are high that you will have access to at least one of these plans in your area.
Most areas of the country have resources and federal or state programs to help you find options for non-emergency medical transportation. Depending on your income and health condition, you may qualify for financial assistance.
Does Medicare Cover Transportation to Doctor Visits?
Medicare does not cover transportation to doctor visits. Some Medicare Advantage Plans may offer transportation to approved facilities as an extra benefit with certain restrictions. For instance, you need to obtain prior authorization for a limited number of one-way trips within your service area over a year. Copays may apply, depending on the plan.
|Medicare Transportation Coverage for Doctor Visits|
|Original Medicare||Medicare Advantage Plans|
|Not covered||Some plans offer transportation to approved facilities, usually limited with prior authorization required.|
Contact your current MA plan to see if transportation is available as an additional benefit. Details about restrictions can be found in the Evidence of Coverage document available to you as a plan member, online or in hard copy format. It’s a good idea to contact your plan to ask about prior authorization requirements if you have transportation needs.
If you are searching on Medicare.gov for a new Medicare Advantage Plan and want a plan with transportation benefits, you can filter your search results under “Plan Benefits.” If you click the box “transportation” in the drop-down menu, your search results list plans available in your area that offer transportation as an additional benefit.
Does Medicare Cover Transportation to and From the Hospital? (Emergency and Non-emergency)
Medicare Part B (medical insurance) covers and pays for medically necessary ambulance transportation at 80% of the cost. You are responsible for the 20% coinsurance payment. Medically necessary services are those that are required to diagnose or treat your medical condition. Services and supplies must meet accepted standards of medical practice.
Medicare Advantage Plans will cover Medicare-covered emergency ambulance transport, but the payment structure may look different. For instance, your cost may be in the form of a copay versus coinsurance.
|Medicare Hospital Transportation Coverage|
|Original Medicare||Medicare Advantage Plans|
|Medically necessary transportation covered at 80% (20% coinsurance required).||Medically necessary transportation covered (copayment may apply).|
Whether your transportation needs are emergent or non-emergent, Medicare payment depends on whether or not you can get to where you are going safely. The deciding factor in whether or not Medicare will help pay for ambulance transport is medical necessity.
If you require ambulance transport, ground transportation is the first option. Medicare may pay for a flight via helicopter or airplane to a hospital if your needs are more emergent and ground transportation is not quick enough to meet your needs safely.
- Medicare will cover ambulance services to or from a hospital, critical access hospital (CAH), or Skilled Nursing Facility (SNF) ONLY if other means of transport endanger your health.
- Medicare may help pay for ambulance transport to and from a dialysis facility if you have End-Stage Renal Disease (ESRD).
- Medicare will only cover and pay for ambulance services to the nearest facility that can give you the care you need. If you choose another facility that is farther away, you will be responsible for the remaining cost after Medicare pays for transport to the closest facility.
- Medicare may pay for limited non-emergency transportation if a physician writes an order stating that it is necessary due to your medical condition.
- When you get ambulance services in a non-emergency situation, the ambulance company may give you an Advanced Beneficiary Notice (ABN) to review and sign in case Medicare doesn’t cover the service. The ABN will indicate what the service will cost if Medicare doesn’t pay. You will have the option to receive the service or not and ask the ambulance company to bill Medicare or not.
How Do You Find Medical Transportation if You Need It?
Find local assistance by using the Eldercare Locator, a public service of the U.S. Administration on Aging. You can learn about transportation resources in your community, find your local Area Agency on Aging, or speak directly to a specialist with Eldercare Locator at 1-800-677-1116.
Search for transportation options that may be available in your community, such as:
- Demand Response (sometimes called Dial-a-Ride)
- Medicaid Non-emergency Medical Transportation (NEMT)
- Public transit or private taxi
- Shared Ride Services (also known as Transportation Network Companies) like Uber and Lyft
- Transportation voucher programs for low-income older adults and people with disabilities
- Volunteer transportation programs
Enroll in PACE (Program of all-inclusive care for the elderly), if you are eligible. PACE is a Medicare and Medicaid program designed to help you meet your health care needs in the community instead of going to a nursing home or care facility. To qualify for PACE, you must:
- Be 55 or older
- Need a nursing home-level of care (as certified by your state)
- Be able to live safely in the community with help from PACE
- Live in the service area of a PACE organization. (Only available in states that offer PACE under Medicaid).
PACE provides transportation to the PACE center for activities or medical appointments if medically necessary. You may be able to get transportation to some medical appointments, too.
Learn More From Our Sources
- Eldercare | Transportation Resources | Last Accessed September 2021
- KFF | Medicare Advantage Plans and Transportation Benefits | Last Accessed September 2021
- Medicare | How Original Medicare Works | Last Accessed September 2021
- Medicare | Medicare Advantage Plans | Last Accessed September 2021
- Medicare | Find a Plan | Last Accessed September 2021
- Medicare | What Part B Covers | Last Accessed September 2021
- Medicare | Medicare Coverage of Ambulance Services | Last Accessed September 2021
- Medicare | PACE: Get Help Paying Costs | Last Accessed September 2021