Medicare coverage for health-related transportation

Ambulances are a critical resource in transporting patients to and from medical facilities, like hospitals. Ambulances are medically equipped and staffed by professionals like paramedics and Emergency Medical Technicians (EMTs).

Emergency transportation

Medicare Part B covers emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger, and you cannot be transported safely in another way. There are certain requirements you must meet for Medicare to cover an emergency ambulance ride:

First, the ambulance must be medically necessary. This means it is the only safe way to transport you.

Second, the reason for your trip must be to receive or to return from receiving Medicare-covered care.

Third, you must be transported to and from certain locations. For example, from your home to the nearest hospital, or from a skilled nursing facility to your home. Medicare will only cover your ride to a medical facility when it's the nearest appropriate facility that's able to give you the care you need.

Finally, the transportation supplier must meet Medicare's ambulance requirements. For example, the ambulance must be staffed by at least two people.

Non-emergency transportation

Medicare Part B sometimes covers non-emergency ambulance transportation. You must meet one of two requirements to have your non-emergency ambulance ride covered:

One, you are confined to your bed. This means you are unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair.

Or two, you need vital medical services during your trip that are only available in an ambulance. For example, you may need medications administered during the trip or need your vital functions monitored.

Medicare may also cover scheduled and regular non-emergency ambulance transportation. To get this kind of transportation covered, your doctor must send the ambulance supplier a written order. The written order needs to state that the transport is medically necessary. It must also be dated no earlier than 60 days before the trip. In some situations, ambulance suppliers must also receive prior authorization from Original Medicare before providing multiple scheduled, non-emergency ambulance rides within a brief period of time (such as within one month).

Transportation by air

Medicare Part B covers medically-necessary transportation in an air ambulance. An air ambulance is a fixed-wing or rotary-wing aircraft that has medical equipment and is staffed by medical professionals. Medical necessity means that you require immediate and rapid ambulance transportation that could not be provided by a ground ambulance. More specifically, air transportation must be needed either because ground ambulance cannot get to you where you are, there is a great distance to travel, or another obstacle involved in getting you to the nearest appropriate facility which occurs across Alaska.

Red flags

Ambulance fraud, errors, and abuse can take various forms. Here are just a few potential examples:

An ambulance was ordered for you, even though one was not medically necessary, and a wheelchair van or other automobile could have transported you safely.

You were transported in an unapproved ambulance like a taxi or rideshare.

Your ambulance was not properly staffed. This normally means that it was not staffed by two emergency medical technicians (EMTs) or paramedics.

You were transported from your house to a non-covered destination like your doctor's office, a community mental health center, a psychiatric facility (outside of a hospital), or an independent lab not connected with a hospital or skilled nursing facility.

For any Medicare related questions, please feel free to contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program. If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.

Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.

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