Medicare Advantage Transportation Benefit: What You Need to Know

Dec 3, 2022

Medicare is a valuable resource for millions of older Americans, but understanding its coverage options and medical benefits can be challenging. One critical form of coverage many Americans need is transportation to medical appointments. Below, our licensed agents from The Modern Medicare Agency will explain all about the Medicare Advantage transportation benefit.

We’ll discuss essential details, including how it works, available Medicare Advantage Plan coverages, and more. If you’re interested in learning more about Medicare Advantage Plans from The Modern Medicare Agency, call today for a free consultation.

Does Medicare Cover Medical Transportation?

Simply put, Medicare plans cover some – but not all – kinds of medical transportation. Medicare breaks down its medical transportation benefits into two categories: non-emergencies and emergencies.

For example, non-emergency transportation would be an appointment at the doctor’s office. Transportation coverage for emergencies would include taking the ambulance to a critical access hospital, general hospital, or skilled nursing facility.

Original Medicare Plans: Do Medicare Part A and Part B Cover Transportation?

Original Medicare, which consists of Medicare Part A and Medicare Part B, will cover emergency ambulance transportation. However, it does not cover most forms of non-emergency medical transportation. Furthermore, Original Medicare transportation coverage may also pay for emergency air ambulance services if you need medical attention faster than the standard ground transportation can provide.

Fortunately, Medicare Part B will cover medically necessary transportation expenses in certain circumstances, including non-emergency ambulance transportation or standard transportation services.

Part B Medicare coverage will only pay for non-emergency transportation to the nearest appropriate medical facility. However, your doctor must officially state that the ride was medically necessary to qualify for Medicare coverage. An example would be someone with end-stage renal disease, which requires regular appointments for dialysis.

To sum it up, Medicare Part A and B usually do not cover non-emergency transportation for beneficiaries.

Medicare Advantage Plans

Private insurance companies that offer policies for a Medicare Advantage Plan (or Medicare Part C) include additional benefits that Original Medicare does not provide. In 2019, the Centers for Medicare & Medicaid Services (CMS) added transportation benefits to Medicare Advantage Coverage from private health insurance companies.

Some companies can now offer Medicare Advantage plans that cover the cost of transportation for services that are essentially health-related, including trips to therapeutic massage, doctor’s appointments, nutrition and wellness providers, etc.

These Medicare Advantage transportation benefits will cover the cost of going to and from the doctor’s office. In addition, certain Medicare Advantage plans cover emergency ambulance transportation. However, some Medicare Advantage plans only cover ambulance services from in-network companies. Otherwise, the beneficiary may be responsible for out-of-pocket costs.

Non-Medicare Transportation Options

In addition, many Medicare Advantage plans offer coverage for non-Medicare transportation services. It’s ideal for Medicare beneficiaries who need transportation to other health care facilities but may not meet Medicare’s transportation benefits criteria. For example, some Medicare Advantage plans pay for rides from companies such as:

  • Lyft
  • Uber
  • Senior Transportation Programs
  • SilverRide
  • GoGoGrandparent

It’s important to remember that you may need prior authorization to receive payment for transportation services from a non-Medicare company. In addition, every plan is different and includes varying transportation and medical insurance benefits, so be sure to call your specific provider to ask what your Medicare coverage includes.

How Medicare Defines Emergencies

Medicare plans cover transportation for emergencies that occur when someone:

  • Is unconscious, in shock, or losing a lot of blood
  • Is undergoing a sudden medical crisis
  • Has a severe health risk
  • Cannot move to another location without help from emergency services
  • Needs medically necessary services
  • Is going to receive a Medicare-approved service
  • Receives ambulance transport from a Medicare-approved ambulance company

Should you experience a medical emergency, Medicare Part B will cover transportation costs up to 80% after you pay your deductible. Your deductible is a Medicare-approved amount for out-of-pocket costs, typically 20%.

Non-Emergency Ambulance Services

When Medicare beneficiaries receive non-emergency ambulance transportation, the ambulance company will first determine whether the case is eligible to have Medicare pay for the costs. If the ambulance company believes Medicare won’t cover transportation costs because the ambulance service wasn’t medically necessary, the beneficiary will receive an Advance Beneficiary Notice of Noncoverage (ABN).

ABN notices are for services that Medicare is unlikely to cover. If you sign the ABN, you agree to pay for the service if Medicare does not cover the costs. Should you refuse to sign the ABN, the ambulance provider will have full discretion regarding whether they will provide transportation. However, if you go in the ambulance and refuse to sign the ABN, there’s still a good chance you’ll have to pay for the trip.

Do Medicare Supplement Plans Cover Transportation?

Private insurance companies offer Medicare Supplement plans, or Medigap plans, which provide supplemental benefits to Original Medicare Part A and Part B coverage. You may not simultaneously enroll in a Medicare Advantage Plan and a Medicare Supplement plan.

While most Medigap plans don’t cover transportation, they can help you pay for any out-of-pocket costs after taking a Medicare-covered service.

Enroll in a Medicare Advantage Plan Today from The Modern Medicare Agency

At The Modern Medicare Agency, we offer several Medicare packages and programs that provide comprehensive health coverage and help pay for medical costs. We know every person has unique healthcare needs, and we tailor our plans to reflect that. Our job is to help you navigate enrollment confidently, making it fast, easy, and hassle-free.

Whether you want Medicare, Medigap, Medicare Advantage, or Part D for medications (here’s a related post that explains what a donut hole in Medicare is), our team of professionals will help you decide which plan suits your needs best.

We know that many Americans can’t afford their own private vehicle, and a standard Medicare plan won’t cover non-emergency transportation, which is why many of our customers choose Medicare Advantage plans.

If you’re interested in learning more about the Medicare Advantage transportation benefit, give us a call. Contact us at The Modern Medicare Agency today at (800) 219-0453 to speak with a licensed insurance agent and request a free consultation.