Everyone knows that if you have Medicare coverage and need an ambulance due to an illness or injury, that ambulance ride will be covered b Medicare. But what happens when you have a doctor’s appointment and require non-emergency medical transportation (NEMT) to get you there? Would that be covered by Medicare?

The answer is, “it is probably covered,” unless you live in a state that restricts the amount of service you can obtain.  Your medical condition may make it difficult for you to keep your physician’s appointment without assistance. It may be you’re confined to a wheelchair or require a stretcher, need constant oxygen monitoring or have certain medical conditions that prevent you from using public transit. These may include end-stage kidney disease, diabetes, asthma or COPD among others. All participants require a doctor’s note outlining the patient’s condition and the reason why the transport is required.

Types of Transport

There are a wide variety of transportation options available to Medicare patients who could qualify for reimbursement when using non-emergency medical transportation. These vehicles could include a sedan, handicap van, stretcher van, or a taxi, with mileage reimbursement to people who provide the transportation. If a patient needs long-distance accommodations or out-of-state treatment, Medicare may cover the least costly and most appropriate mode of transportation. It’s all determined on a case-by-case basis.

There are also non-emergency medical transportation brokers who work to match patients with transit providers in the most cost-effective and efficient ways. These brokers manage a variety of tasks that include determining member eligibility, provider network management, provider credentialing, trip approvals, dispatch and reporting. States that use the broker process utilize a competitive bidding process that selects brokers based on their experience, cost, performance and other factors.

Medicaid Benefits

If you’re 65 or older and have Medicare Part B, non-emergency transportation services are usually covered as allowable expenses under Part B. It usually is required to be provided by an authorized provider or ambulance company and the patient is not able to use any other type of transportation without endangering his or her health.

The Center for Medicare & Medicaid Services (CMS) provides complete details on these benefits on their website. As you would imagine, there are limitations and exclusions to their coverage, including how many trips per month are allowed, distance caps and others limits.

Cost Savings

There is no question that reimbursing patients for non-emergency medical transport can save both the government and states money. One study showed that for every $1 paid out in NEMT benefits, Medicare or Medicaid would save over $11. That adds up to millions of dollars each year.

Each year, more than 3.6 million people miss a doctor’s appointment due to transportation issues. By using proactive healthcare management techniques like NEMT, costs can drop by as much as 800% - a staggering number. Just compare the average cost of an emergency room visit with the cost of a NEMT trip. The emergency room visit comes in at an average of $2,100. The NEMT trip: $10 - $20! And while costs are important, the overall improved health of the patient by being able to keep their doctor appointments is immeasurable.

Other Options

If you’re currently not eligible or don’t qualify for non-emergency medical transportation, there may be other options available to you in your community through a variety of local organizations. The local Area Agency on Aging may have access to transportation services or can help you find transportation to your local physician. Other local charities are also available in various communities around the country who can provide assistance with transportation.

Published by Zachary McGavin