How Does Medicare Cover Transportation?

Original Medicare (Part B) covers medical transportation provided by ambulance to a covered destination for medically necessary services.

Medicare Part B covers most emergency and some nonemergency transportation needs. But many Medicare Advantage plans include even more transport, such as a rideshare service to an approved fitness center.

Understanding how Medicare handles transportation coverage and payments can help you estimate your costs.

Does Medicare cover emergency transportation?

Original Medicare Part B (medical insurance) pays for ambulance transportation for Medicare patients.

Specifically, it pays for emergency ground ambulance transport for medically necessary services when transportation in another vehicle could risk your health. This can be to a hospital, critical access hospital or skilled nursing facility.

Medicare may pay for an emergency air ambulance to a hospital if you need a quick and urgent response that ground transportation can’t provide.

What is an emergency under Medicare?

In general, Medicare considers a situation to be an emergency when:

Does Medicare cover nonemergency transportation?

Medicare Part B may pay for limited nonemergency ambulance transportation if your doctor says it’s medically necessary. For example, someone with end-stage renal disease (ESRD) may qualify for payment of dialysis transportation under Medicare.

Medicare may also cover nonemergency transportation when a person is:

If an ambulance company provides nonemergency transport, and it thinks Medicare won’t cover it, it must give you an Advance Beneficiary Notice of Noncoverage (ABN). This is to warn you that you may have to pay for the services out of pocket.

Whether transportation is for emergency or nonemergency care, the Medicare transportation benefit only covers ambulance services to the nearest medical facility that can treat you.

If you receive services that Medicare does not cover, you may have to pay some or all of the costs. If you can, ask why your doctor or an ambulance company is recommending transport to a nonlocal facility and whether Medicare will cover the charges.

Original Medicare transportation example

If Original Medicare is your only coverage, your total costs will include your monthly Medicare Part B rate, your calendar year deductible and 20% coinsurance.

When calculating a claim payment, Medicare uses the Medicare-approved amount. This is the amount that Medicare will pay a doctor or supplier that accepts the assignment. It may be less than the actual amount a doctor charges.

Assignment means a doctor agrees to accept (or, by law, must accept) the Medicare-approved amount as payment in full. Most doctors accept the assignment, but it’s a good idea to check to be sure. If the doctor doesn't accept the assignment, you may get a bill for the difference.

Below we have provided an example of how Original Medicare would pay for an ambulance bill:

How a Medicare demonstration may impact nonemergency ambulance coverage

Demonstration projects allow the Centers for Medicare & Medicaid Services (CMS) to test and measure the effects of potential program changes. These could be new types of services and delivery methods, as well as new payment approaches.

Under one of these demonstrations, CMS is testing a new Medicare model for ambulance transport in eight states and Washington, D.C.

If you live in one of these states and use nonemergency ambulance services regularly, you may need to take extra steps to submit your Medicare medical transportation charges for review.

This Medicare demonstration applies if you receive scheduled, nonemergency ambulance transportation at either of these frequency levels:

Under the demonstration, you or the ambulance company can ask Medicare to give the OK anytime before your fourth round trip in a 30-day period. This will let you and the company know earlier whether Medicare might cover your services.

If Medicare denies your request and you get the services anyway, Medicare will reject the claim and the ambulance company may bill you for all charges.

How do Original Medicare and a Medigap (Medicare Supplement) plan cover transportation?

Original Medicare and your Medigap plan work together to cover your Medicare-approved transportation costs.

Medigap plans supplement Original Medicare, meaning they "fill the gap" or cover costs left over after Medicare pays. If Medicare rejects a transportation claim and your Medigap plan does not cover the service, then you would be responsible for paying the full amount for the ambulance.

When you get services, show both your red, white and blue Medicare card and your Medigap ID card to your provider. Your provider then submits the charges to Medicare.

If Medicare approves the service, it will cover its portion. Then, Medicare will use an automated "crossover" system to notify your Medigap insurance company of the remaining charges. Generally, neither you nor your health care provider needs to file a separate claim with your Medigap plan.

Original Medicare plus Medigap transportation example

After the cost of your Medicare Part B and Medigap rates, your next out-of-pocket expense is the annual Part B deductible. Only Medigap Plans C and F cover this cost, and only for current members. That's because Medicare no longer offers Plans C and F.

Once you meet the Part B deductible, you’ll be responsible for coinsurance of 20% of the Medicare-approved amount for medical services, including transport. Medigap plans cover these coinsurance costs in full, with two exceptions.

Do Medicare Advantage plans cover transportation?

Medicare Advantage includes transportation benefits in all Advantage plans. The benefits must be at least equal to what Original Medicare provides. However, many Medicare Advantage plans offer enhanced transportation benefits to help improve access to care.

For example, according to the Medical Transportation Access Coalition, your Medicare Advantage plan may partner with a specific transportation company to provide routine transportation services. It can also partner with a rideshare service such as Lyft or Uber. Sometimes, the benefit is part of a SilverSneakers fitness program to help you get to a participating gym.

Because benefits and coverage levels vary by plan and location, there are no set Medicare Advantage transportation costs.

Some plans require a copay, and others charge coinsurance for covered transportation services. And some Medicare Advantage plans provide routine transportation benefits, while others cover only ambulance charges.

If medical transportation is a factor in choosing between a Medigap and Medicare Advantage plan, it is important to research and understand the differences in coverage.

What if insurance doesn't cover my medical transportation needs?

In the end, Medicare may not cover all transportation needs for seniors with Medicare. If you need routine medical transportation that’s not on your Medicare plan, you could still get help through groups like those listed here. Contact the office nearest you to learn more.