Medicare and Medicaid: Transportation coverage

For many seniors, getting to a doctor’s appointment isn’t simple. This is especially true for those who have mobility challenges, lack affordable access to transportation or live in a rural community. And if you need immediate care, transportation and transportation coverage can be even harder to sort out.

If you’re on Medicare or Medicaid or you’re dual eligible and have both, it’s important to know what kind of transportation is available to you. Both Medicare and Medicaid can help with transportation coverage in emergency situations, as well as routine health care services, but coverage can vary by plan. Here’s what you need to know.

Medicare coverage for emergency transportation

Medicare will cover ground ambulance transportation when you need urgent, medically necessary health care from a hospital, critical access hospital, rural emergency hospital or skilled nursing facility. If your health is in danger and other methods of traveling, like a car or bus, aren’t safe for you, Medicare will cover ambulance services to the closest hospital or medical facility. If you choose another hospital farther away, you’ll have to pay the extra cost for the extra distance.

How Medicare covers ambulance rides

Medicare Part B, also known as medical coverage, covers ambulance rides. For ground ambulance rides, you’ll typically pay your 20% coinsurance after you’ve met your yearly Part B deductible. Ambulance companies can’t legally charge you more, with one exception – if you’re transported by a critical access hospital in a rural area, then pricing and Medicare coverage can vary.

How Medicare covers air ambulance rides

Medicare will sometimes pay for emergency air transportation via airplane or helicopter, depending on the severity of the emergency and the location of the most appropriate medical facility. Much like ground ambulance services, Medicare Part B will typically cover air ambulance ride costs at 80%, and you’ll pay the remaining 20% out of pocket after meeting your deductible. If you are part of a membership service like Life Flight, Original Medicare will not cover membership costs.

Medicare coverage for non-emergency transportation

Typically, Original Medicare won’t cover rides to routine doctor or specialist visits – even to things like dialysis. However, you’re not out of options.

In some cases, Part B covers non-emergency ambulance transportation if deemed medically necessary by your doctor. And if you have a Medicare Advantage (Part C plan), you will likely have more benefits available to you.

Medicaid coverage for emergency transportation

Like Medicare, Medicaid will cover the cost of emergency transportation for those who are eligible. If you’re experiencing a medical emergency like a stroke or extreme injury, a ground ambulance will take you to an emergency room or medical facility. Pre-approval is not required for emergency transportation.

How Medicaid covers air ambulance rides

In cases of a medical emergency, Medicaid may cover air ambulance rides when you’re experiencing a potentially life-threatening health issue and do not have access to the care you need from a local health facility.

Medicaid coverage for non-emergency transportation

Unlike Medicare, Medicaid will cover non-emergency medical transportation (NEMT) to clinics, hospitals and other facilities that offer Medicaid-covered health services, for those who are eligible.

Eligibility can depend on your needs, location and access to transportation. For instance, you might be a candidate if you don’t have a driver’s license or car, or if you have a physical or mental disability that rules out traveling by yourself.

To learn more about what Medicaid will cover, refer to the informational packet you received when you enrolled or contact your health plan.