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If you have a family member or loved one who needs medical accommodations, you may be considering non-emergency medical transportation. With that in mind, you might be curious about the cost and whether you can expect Medicare to cover the expenses or if you will have to pay out of pocket. Consider the following factors that can help determine whether Medicare will cover non-emergency medical transportation.

It Depends

Typically, Medicare doesn’t cover non-emergency medical transportation. However, Medicare may provide coverage if a doctor certifies the trip as medically necessary to protect the patient’s health. Even with a written certification from a doctor, coverage isn’t a guarantee unless you seek prior approval from Medicare. Read on to learn more about the circumstances Medicare is most likely to cover.

Medical Necessity

If a doctor deems NEMT a medical necessity, Medicare may cover the cost. However, this means that the doctor must state that special transportation is necessary due to the patient’s health condition. For example, Medicare is more likely to cover transit if the patient is unable to get out of bed, walk on their own, sit in a chair, or if they require medication to be administered or vital function monitoring.

Endangered Patient Health

NEMT may be necessary if the patient needs transit to a medical facility to treat or diagnose their health condition and any other form of transportation may endanger their health further. Once again, this circumstance requires written approval from a doctor before Medicare will agree to cover the cost.

Location

If the patient lives in an area where no other suitable transportation is available, then Medicare may cover NEMT. Furthermore, special transit may be a necessity in rural areas because of the poor road conditions, which may worsen the patient’s health condition.

If you or your loved one is in need of long-distance non-emergency medical transportation, contact our team at TransMedCare. Knowing whether Medicare covers non-emergency medical transportation before booking the trip may save you from paying out of pocket to cover the cost.