Non-emergency transportation (NET) refers to a ride that helps a person get to a healthcare service, such as a scheduled doctor’s appointment, a physical therapy session, or a pharmacy. This type of transportation is distinct from emergency services, which involve an ambulance responding to a sudden, life-threatening situation. Determining whether Medicare covers these routine rides is complex and depends entirely on the specific type of plan a beneficiary holds. Coverage rules for a taxi ride to a routine check-up are significantly different from the rules for an ambulance trip that requires medical supervision.
Coverage Under Original Medicare
Original Medicare provides very limited coverage for non-emergency transportation. This coverage is strictly confined to situations where transport is deemed medically necessary and usually involves an ambulance service. Routine transport, such as a ride in a car, taxi, or van to a standard physician’s office, is not covered under this program.
Medicare Part B covers ground ambulance transport only when using any other method of transport would endanger the patient’s health. For example, coverage may apply if the patient is bed-confined, meaning they are unable to get up from bed without help, cannot walk, and cannot sit in a chair or wheelchair. The service must be provided by a Medicare-approved supplier and is generally limited to transport to the nearest facility equipped to provide the required care.
Non-emergency ambulance transportation can be covered in specific, limited instances, such as for patients with End-Stage Renal Disease (ESRD) requiring scheduled, round-trip transport for dialysis treatments. A physician must provide a written order certifying that the transport is medically required. Even in these pre-scheduled situations, the medical necessity must be clearly documented, confirming the patient requires skilled medical supervision or monitoring during the trip itself. Beneficiaries are responsible for the Part B deductible and a 20% coinsurance of the Medicare-approved amount for these services.
Supplemental Benefits in Medicare Advantage Plans
Medicare Advantage (MA) plans are offered by private insurance companies that contract with Medicare. While these plans must cover everything Original Medicare does, they frequently offer additional benefits, which can include non-emergency transportation. This routine NET is an optional supplemental benefit, meaning coverage varies significantly and is not guaranteed across all MA plans.
The transportation provided by these plans helps members access non-urgent health-related destinations, such as trips to a primary care provider, a specialist, or the pharmacy. The mode of transport is typically a standard vehicle, a wheelchair-accessible van, or a pre-arranged ride-share service. The plan contracts with a specific vendor to provide these services.
These supplemental transportation benefits always come with specific limitations. Most plans impose a set maximum number of one-way trips per year, which can range widely, and may also include a maximum mileage limit per trip. A plan member must consult their specific Evidence of Coverage (EOC) document or contact their plan administrator to verify the exact number of trips and approved destinations available.
How to Arrange Transportation Services
The process for arranging non-emergency transport differs significantly depending on the type of coverage. For medically necessary ambulance transport covered by Original Medicare, the process begins with the healthcare provider. A physician must certify in writing that the use of a ground ambulance is required because other means of transport would be detrimental to the patient’s health.
The ambulance provider must be Medicare-approved and will handle the billing directly with Medicare Part B. For frequent, scheduled non-emergency ambulance trips, the supplier may be required to request prior authorization from Medicare. If the ambulance company believes Medicare may deny the claim, they must issue an Advance Beneficiary Notice of Noncoverage (ABN). This notice informs the beneficiary of their potential financial responsibility for the service.
For routine non-emergency transportation covered by a Medicare Advantage plan, the process is coordinated through the plan’s administrative system. The beneficiary must contact the plan’s customer service line or the designated transportation vendor to schedule a ride. Scheduling must often be done at least 48 to 72 hours in advance of the appointment. When scheduling, the member must specify the approved destination and arrange a return trip, sometimes using a “will call” option for flexibility.