Does humana cover transportation to doctors appointments

Summary:

Transportation to doctor appointments is not generally covered by Original Medicare (Part A and Part B). However, some Medicare Advantage plans may cover transportation to doctor appointments. You may also be able to get non-Medicare transportation to doctor appointments through various organizations, such as your local Area Agency on Aging (AAA).

Ambulance Coverage

Medicare Part B (Medical Insurance) does cover ground ambulance transportation when traveling in another vehicle could endanger your health and if you need medically necessary services from the following:

• Hospital
• Critical access hospital
• Skilled nursing facility

Medicare can pay for emergency ambulance transportation in an airplane or helicopter if you need immediate and rapid transport that ground transportation can’t provide to you. Some cases may have Medicare pay for limited, medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that the transportation is medically necessary. An example of this is someone with End-Stage Renal Disease needing a medically necessary ambulance transport to a kidney dialysis facility. After you meet the Medicare Part B deductible, you are responsible for paying 20% of the Medicare-Approved Amount.

Additionally, it is important to note that Medicare will only cover ambulance services to the nearest appropriate medical facility that’s able to give you the care you need.

Does Original Medicare cover Transportation for Medical Reasons?

Original Medicare (Part A and Part B) generally does not cover transportation to get routine health care. However, it may cover non-emergency ambulance transportation to and from a health-care provider. You need to have a health condition diagnosed or treated and other forms of transportation could endanger your health. Your doctor must provide a written order verifying that ambulance transportation is medically necessary because of your health condition. 

What is Non-Emergency Medical Transportation (NEMT)?

Non-Emergency Medical Transportation is a great benefit for those in need of assistance going to and from medical appointments.  

Does Medicaid cover Non-Emergency Transportation?

Medicaid does cover the cost of emergency medical transportation for those eligible and their medical needs are immediate. This includes being seriously injured, or the case of a heart attack for example. In these cases, an ambulance or medical flight may be required and pre-approval for emergency transportation is not required. Non-emergency transportation, such as needing a ride to a medical appointment, is not considered an emergency but rides may still be available. Medicaid can cover rides to and from a doctor’s office, the hospital, or another medical office for Medicaid-approved care.

Medicaid may cover your ride to a doctor appointment if:

• You don’t have a working vehicle or a driver’s license.
• It’s not safe for you to drive or wait for a ride to a doctor appointment because of a health condition, physical disability, or mental disability.
• You have no other reasonable means of getting to the doctor.

If your ride to a doctor appointment qualifies, Medicaid-covered transportation could include:

• Car
• Van or carpool
• Bus
• Subway
• Taxi

It’s up to each Medicaid program to decide the most appropriate means of transportation for your ride to a doctor appointment. Keep in mind that Medicaid programs are state-run, and each state has its own criteria for medical transportation coverage.

If you use an ambulance company based in New Jersey, Pennsylvania, or South Carolina, you may be affected by prior authorization rules if you need non-emergency, scheduled, medically necessary ambulance services 1) three or more times over a 10-day period or 2) at least once a week for three or more weeks. To find out if these rules affect you, contact Medicare at 1-800-633-4227 (TTY users, dial 1-877-486-2048), 24 hours a day, seven days a week.

What non-Medicare transportation options might be available?

Area Agency on Aging (AAA)

For beneficiaries who do not qualify for non-emergency ambulance transportation, there may be non-Medicare transportation services available in their immediate area through local organizations. For instance, your local Area Agency on Aging (AAA) may be able to help you find transportation to and from your health-care provider. To locate a State and/or Area Agency on Aging, you can use the SUA/AAA Finder on the organization’s website.

Senior Transportation Options

If you’re looking for a ride to a doctor appointment, visit Eldercare.gov for more information on senior transportation services in your city. You can also contact your local Area Agency on Aging if you need a ride to a doctor appointment and need help finding resources where you live.

Medicaid or the Program of All-Inclusive Care for the Elderly (PACE)

If you are eligible for Medicaid or the Program of All-Inclusive Care for the Elderly (PACE), these organizations may also provide transportation for routine medical care. Visit www.Medicaid.gov or www.Pace4you.org for more information.

Medicare Advantage and Special Needs Programs (SNPs)

As of 2022, around 38 percent of Medicare Advantage plans and 87 percent of Special Needs Plans (SNPs) are authorized to offer innovation benefits, including Medicare transportation to doctor’s appointments. Medicare Advantage is another way to get your Medicare Part A and Part B benefits through a private insurance company approved by Medicare. Around 97 percent of Medicare beneficiaries have access to at least one Medicare Advantage plan available for general enrollment that offers some extra benefits regarding transportation assistance that traditional Medicare doesn’t cover in 2022. 

Special Needs Plans are intended to serve a disproportionately high-need population. A larger portion of SNPs provide enrollees with transportation benefits (87%). However, as of 2021 the vast majority of plans do not offer Special Supplemental Benefits for the Chronically Ill (SBCI). Only 2.9 percent of those with individual plans and 12.4 percent of SPNs received access to transportation coverage for non-medical needs in 2021. 

To find a Medicare Advantage plan that may cover Medicare transportation, enter your zip code on this page.

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