Medical Transportation: What Medicare Actually Covers
Medicare is a federal health insurance program that is eligible for only;
• People aged 65 or over
• Certain young people with disabilities
• People with severe Renal Disease.
There are generally three kinds of Medicare; A, B, C (also known as Medicare Advantage), and D. Medicare A covers hospital insurance. Medicare B covers Medical Insurance. Medicare C is a combination of Medicare plans A, B, C, and often, D. Medicare D includes prescription drugs.
When it comes to medical transportation, there are often some ‘grey areas’ with regards to what aspect of your Medicare insurance plan covers medical transportation, and under what circumstances make this coverage valid. Thus, this blog post aims to clarify what Medicare may or may not include with regard to medical transportation.
Medicare doesn’t cover all medical transport. Neither Medicare A nor B cover any standard transportation of a patient under normal circumstances – in non-emergency situations. Although, Medicare B may include the transportation of a patient from their home to a medical facility in a non-emergency scenario. However, this is only possible under the condition that the patient’s doctor explicitly writes a formal certification that the patient’s life or health may be endangered if regular ambulance service is used.
While a written clarification from a doctor is necessary for a patient’s non-emergency medical transport to be covered under Medicare B, there is no 100% guarantee that the claim will be acknowledged. To absolutely clarify and put the claim beyond doubt, the patient will have to demand that the doctor’s office gets prior approval from Medicare. So, if a patient hires medical transportation based on their discretion or limited knowledge about what Medicare covers, they risk bearing the entire cost of the service alone.
Generally, the Medicare C plan is an extension of both Medicare A and B plans. With the Medicare C plan, all the benefits of Medicare A and B are included. However, some extra services may also be covered under this plan. Be sure to double-check with Medicare to find out what specific services your Medicare C plan covers.
What Medicare Covers
It is necessary to highlight that Medicare does not cover most non-emergency transportation cases. To be eligible for non-emergency transport coverage under Medicare B, which usually only covers 80% of the entire non-emergency medical transportation cost, the service must be approved beforehand. Typically, this can only be done if the doctor of the patient deems it a medical necessity at the time.
Medicare may also cover medical air transportation if it can be proven that an ambulance will not be a good fit given the nature of the patient and that medical air transportation such as an airplane or helicopter is absolutely crucial to the survival of the patient.
In summary, regardless of the Medicare plan you are covered by (A, B, or C); for any non-emergency medical transportation claim to be valid under the Medicare scheme, two criteria must be met;
• A doctor or licensed medical personnel must first deem the need for the medical transportation necessary, solely based on medical grounds, and prior approval by Medicare.
• The care must be administered by a medical personnel or healthcare provider that is covered by Medicare.