I need some help getting to and from treatment I have scheduled for next month. Will Medicare cover my scheduled transportation?
-Norman (Riverside, CA)
Depending on your circumstances, Original Medicare may cover scheduled/regular non-emergency ambulance transportation if the ambulance supplier receives a written order from your doctor in advance stating that transport is medically necessary. However, Medicare does not cover ambulance transportation just because you lack access to alternative transportation. The order must be dated no earlier than 60 days before the trip.
For example, if you are receiving dialysis treatments, Medicare may cover ambulance services to and from your home to the nearest dialysis facility, if other transportation could endanger your health.
Keep in mind that Medicare does not require a doctor’s written order for coverage of emergency ambulance transportation.
In certain states, ambulance suppliers must receive prior authorization from Medicare before providing scheduled, non-emergency ambulance transportation. These states include:
- District of Columbia
- New Jersey
- North Carolina
- South Carolina
- West Virginia
If the prior authorization request is approved, Medicare should cover your ambulance trips so long as the ambulance supplier also receives a written order from your doctor stating that transport is medically necessary. If Medicare denies your request, the ambulance supplier or you should submit a new prior authorization request. You have the right to appeal denials. Keep in mind that if you choose to receive services after a denial, you may be responsible for the full cost of your ambulance transportation.
If Medicare does not cover the kind of transportation you need, you may have other options. For example, Medicaid may cover some types of transportation that Medicare does not. Additionally, some Medicare Advantage Plans may cover additional types of transportation as a supplemental benefit. You can also contact ElderCare or your local State Health Insurance Assistance Program (SHIP) to learn about local resources that may be available to you.
I hope this helps!