Does Medicare Cover Non-Emergency Medical Transport?

Non-emergency medical transport (NEMT) is not included in the Medicare package, except under special circumstances. These circumstances are warranted when a physician puts into writing that the medical trip is necessary. If granted, only a healthcare company duly registered with Medicare is allowed to provide transportation medical services.

As mentioned earlier, Medicare covers NEMT under specific conditions. But some rules guide Medicare coverage, and it is explained below in detail.

Under which conditions does Medicare cover NEMT?

Medicare Part A and Medicare Part B indicate that NEMT is not covered in the package under normal conditions. However, Medicare Part B covers NEMT only if a doctor provides a written certification indicating the necessity of transportation medical services for protecting the patient’s health.

Even with a physician’s certification implying the medical necessity of the trip, there is no guarantee that NEMT will be covered. To get absolute certainty about the NEMT costs being covered, you need to get an endorsement from Medicare before the doctor provides a certification.

In most cases, the patients have to bear the expenses associated with the trip. Unfortunately, the cost of transportation medical services is on the high side.

How payments can be made with Medicare C for NEMT

Medicare Part C, or better yet, Medicare Advantage Plan, allows people to have the full benefits of Medicare through a private health insurer. Every service included in Medicare Part A and Part B is integrated into Medicare Part C.

In some cases, the Medical Advantage Plan covers more than just Part A and Part B. It also lists non-emergency medical transport as one of the services offered.

If you want to know more about what the Medical Advantage Plan covers, you should discuss it with your health insurance provider to give you more details. However, Medicare does not cover the entirety of NEMT costs as the payments are often capped at 80% of the transportation medical services costs.

There are two primary criteria patients need to meet before being considered eligible for Medicare coverage of NEMT. They include:

1. The trip must be “medically necessary”

2. Only an approved healthcare company is allowed to provide transportation medical services in a Medicare plan

What does “medically necessary” mean?

According to Medicare, “medically necessary” refers to services or supplies that are required for the diagnosis and treatment of medical conditions, and must align with the standards of medical practice. Before embarking on any medical transport paid for by Medicare, a physician needs to certify that the trip is medically necessary.

For example, a patient with End-Stage Renal Disease will need a NEMT vehicle equipped with a dialysis machine for the medical trip. The term “medically necessary” also applies to a cystic fibrosis patient who needs a mechanical ventilator to go on a doctor’s appointment. 

Conclusion

Usually, healthcare providers recommend services that are not included in the Medicare package. Hence, discussing with your doctor about the coverage of NEMT by Medicare is necessary. In some cases, the health insurance company has the answers to such issues. Therefore, contacting your healthcare provider will help you avoid the high bill costs associated with transportation medical services.