Non-Emergency Medical Transportation Insurance: Does Medicare Cover This?

Non-Emergency Medical Transportation Insurance

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US disability rates are on the rise. So, it should be no wonder the non-emergency medical transportation market is growing, too. Experts project the market for these services will reach over $10 million by 2028.

Older adults and individuals with disabilities are the primary customers of non-emergency medical transportation services. But unfortunately, not everyone can afford these services when they need them.

Luckily, non-emergency medical transportation insurance can help lower the cost. That way, patients can get the medical attention they need even when they can’t access transportation on their own.

Which transportation insurance providers offer coverage for non-emergency medical transportation services? We are answering this question in this guide, so keep reading to find out.

What Is Non-Emergency Medical Transportation Insurance?

Non-emergency medical transportation (NEMT) is a service for patients who need medical care but do not have a way to get there. It is ideal for older adults, disabled people, and low-income individuals.

It may help to contrast NEMT with emergency medical transportation (EMT). EMT services are required when someone needs emergency transportation to the hospital via ambulance. This need may arise in the following situations:

  • A sudden medical issue
  • A medical issue that presents a threat to the person’s life or health
  • Rapid blood loss
  • Unconsciousness
  • Life-threatening injury

Emergency medical care and transportation are among the 10 essential health benefits. That means all Original Medicare and Medicare Advantage plans cover it, and are considered medical transportation insurance. Unfortunately, NEMT does not have the same status.

Does Original Medicare Cover NEMT?

Original Medicare does not cover NEMT unless it is medically necessary, so keep this in mind when considering medical transportation insurance. Medically necessary services are those that a patient needs to treat a disease, health condition, injury, or illness.

Does Original Medicare Cover NEMT?

Here’s an example of when NEMT may be medically necessary. Say you have an end-stage renal disease diagnosis. In this case, Medicare may cover NEMT rides to and from your dialysis treatment center and would then be considered medical transportation insurance.

Other situations where NEMT may be medically necessary include if you can’t walk or stand without assistance. Individuals who can’t use a wheelchair or sit in a chair may also need medically necessary NEMT services.

If your transportation needs are medically necessary, Medicare Part B will cover some of the costs and is considered medical transportation insurance. Medicare Part B helps to cover outpatient services received outside of a hospital setting.

If your transportation needs are not medically necessary, Original Medicare will not cover it, and is not considered medical transportation insurance. But the good news is that some Medicare Advantage plans offer expanded benefits for NEMT services.

Do Medicare Advantage Plans Cover NEMT?

Yes, many Medicare Advantage plans do cover NEMT. Patients can receive benefits for rides to and from doctor’s appointments and these plans are considered medical transportation insurance. They can also get benefits for rides to specialty care centers and other medical facilities.

Depending on your plan, you may have access to even more NEMT benefits. For example, some Medicare Advantage plans will cover rides to and from fitness centers and cooling facilities.

Special Needs Plans (SNPs) provide the greatest amount of NEMT Medicare coverage. SNPs are ideal for patients with chronic illnesses. You must qualify for Medicare and Medicaid to enroll in an SNP.

Does Medicaid Cover NEMT?

The Medicaid program does cover NEMT services for many beneficiaries. You can get coverage for rides to and from doctor’s offices, hospitals, and other medical facilities if you:

  • Don’t have a car
  • Don’t have a driver’s license
  • Have a mental or physical disability that prevents you from traveling on your own

Does Medicaid Cover NEMT?

Importantly, medical necessity still applies under Medicaid. This can get confusing because each US state defines when NEMT is medically necessary and when it isn’t. We will discuss the rules in California below.

Who Can Receive Medicaid Coverage for NEMT in California?

You can receive Medicaid coverage for NEMT in California with a doctor’s prescription. Doctors may prescribe NEMT if you are unable to use public transportation and do not have access to private transportation of your own.

Anyone with Medicaid in California can access NEMT benefits. However, these services are also available to pregnant people who have an NEMT prescription.

What Are Medically Necessary Reasons for NEMT in California?

In California, medically necessary reasons for NEMT allow you to receive Medicaid coverage. These reasons include the three we listed above.

People who have a driver’s license and access to a car but no money for gas also qualify for NEMT benefits in California.

What Types of Medical Care Are Eligible for NEMT Medicaid Benefits in California?

Medicaid-covered medical services are eligible for NEMT Medicaid benefits in California. According to the California Department of Health Care Services, that includes the following situations:

  • Medicaid-covered medical appointments
  • Dental appointments
  • Prescription medical pick-ups
  • Prescribed medical supplies and equipment pick-ups

The only services not covered under the NEMT benefit are ones Medicaid doesn’t cover.

For example, say you need non-medically necessary plastic surgery. In this case, Medicaid will not cover your surgery. As such, the program will not pay for your ride to and from your appointment.

Who Can Provide NEMT Services in California?

Licensed medical transportation companies can provide NEMT services in California. California Medicaid (i.e., Medi-Cal) will not provide benefits unless it has approved and enrolled the service provider.

Looking for Professional NEMT Providers in Los Angeles?

Non-emergency medical transportation insurance may provide benefits for covered individuals. However, you must have a doctor’s prescription. Then, Medicaid and some Medicare Advantage plans may help pay for your ride.

Professional NEMT Provider in Los Angeles

Do you need a licensed, professional NEMT provider in the greater LA area? Affinity Transit offers rides to medical facilities across Los Angeles and Ventura Counties. Contact us to schedule your first ride.

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