Skip to content

Is Non-Emergency Medical Transportation Covered by Medicare?

Non-emergency medical transportation (NEMT) falls into somewhat of a gray area when it comes to Medicare insurance coverage, leaving Medicare beneficiaries unsure of what the program covers.

What qualifies as non-emergency medical transportation?

First, it’s important to cover the basics. For emergency transport in an ambulance, Medicare covers all costs, as long as the ambulance brings the patient to the nearest hospital. If the ambulance travels to a hospital farther away for a non-medical reason, such as patient preference, Medicare will only cover what it would have cost to travel to the nearest hospital. However, there are medical reasons for traveling farther, such as if the patient requires care from a specialist that’s not located at the nearest hospital. There is no limit on the amount of emergency trips that Medicare will cover.

Non-emergency medical transportation involves transportation in an ambulatory vehicle for non-emergency reasons. This includes transportation to and from medical appointments such as doctor visits or physical therapy, trips home from the emergency room, or transfer between hospitals, among other scenarios. While patients aren’t facing an emergency, they do require the level of care provided in an ambulatory vehicle. For example, perhaps the patient uses a wheelchair that must be secured properly. Or perhaps the patient requires medical supervision on their trip.

What does Medicare cover?

These scheduled, non-emergency trips all involve medical treatment in one form or another, whether that’s traveling to receive medical care, or traveling back after receiving medical care. For this reason, many Medicare beneficiaries assume that the costs will be covered by their Medicare insurance. However, that’s often not the case.

Medicare Part A:

Medicare Part A does not cover non-emergency medical transportation.

Medicare Part B:

By default, Medicare Part B does not cover non-emergency medical transportation. However, it is possible to secure coverage on a case-by-case basis. For this to happen, a patient’s doctor needs to first prescribe NEMT for medically necessary reasons. The doctor must write a letter explaining these reasons and submit that letter to insurance. For example, if a patient’s immune system is compromised, the patient’s doctor may determine that the use of public transportation would expose the patient to too many germs and could be life-threatening.

While a doctor’s written statement is necessary to secure Medicare coverage for non-emergency medical transportation, it does not guarantee Medicare coverage. The best option is for a patient to ask their medical provider to seek prior approval from Medicare Part B before scheduling NEMT. If coverage is approved, Medicare Part B will cover 80% of the Medicare-approved amount for non-emergency ambulance services.

Medicare Part C:

Medicare Part C, also known as Medicare Advantage plans, are Medicare-approved private insurance plans. These plans are required to provide the same benefits as Medicare Part A and Medicare Part B. Often times, they provide additional benefits as well. Patients can contact their Medicare Part C provider to check on whether coverage is provided for NEMT. If coverage is not provided already, it may be possible to change the plan to one that does provide NEMT coverage during the next enrollment period.

Potential Changes on the Horizon:

While Medicare non-emergency medical transportation coverage is limited, change may be on the horizon. Right now, Medicare is running a pilot program to provide coverage to patients who receive scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period, or at least once per week for 3 weeks or more. The program is underway now in New Jersey, Pennsylvania, South Carolina, Maryland, Delaware, the District of Columbia, North Carolina, Texas, Virginia, and West Virginia.

For additional questions regarding non-emergency medical transportation insurance coverage, feel free to call Integrity Medical Transportation in the Dallas-Fort Worth Metropolitan Area. As an insurance provider for NEMT companies, we work hard to stay informed on the ins and outs of the NEMT industry. Contact us today for more information.