Does Medicare Pay for Transportation From Hospital to Rehab?

Understanding whether Medicare covers transportation from a hospital to a rehabilitation facility is important for discharge planning. Medicare’s rules for medical transportation dictate when and how transport services, including ambulance services, are covered.

Medicare’s Coverage Rules for Medical Transportation

Medicare Part B covers medically necessary ambulance services. This applies when a patient’s health condition requires professional medical observation or intervention during transport, or if other transport means would endanger their health. “Medically necessary” means using a private car, taxi, or wheelchair van would be medically unsuitable for the patient’s condition.

Ambulance services are categorized into emergency and non-emergency transport. Emergency services are covered when a patient’s health is in serious danger, requiring immediate medical attention, and an ambulance is the fastest, safest means of transportation to the nearest appropriate medical facility. This includes situations like heart attacks or severe injuries.

Non-emergency ambulance services may also be covered by Medicare Part B under specific, limited circumstances. A physician’s written order must certify that ambulance transportation is medically necessary because other methods are medically contraindicated. This might include transfers for specialized care or scheduled appointments. Coverage may be considered if a patient is confined to bed, unable to walk, or requires vital medical services only available in an ambulance.

Medicare generally does not cover non-emergency transportation by car, taxi, or wheelchair van. For covered ambulance services, Medicare Part B typically covers 80% of the Medicare-approved amount after the annual Part B deductible has been met. Patients pay 20% coinsurance. Prior authorization might be required for frequent non-emergency trips.

Transportation to Skilled Nursing Facilities and Inpatient Rehabilitation Facilities

Medicare’s general transportation rules apply to transfers from a hospital to a post-acute care facility, such as a Skilled Nursing Facility (SNF) or an Inpatient Rehabilitation Facility (IRF). An SNF provides skilled nursing care and rehabilitation services short-term after a qualifying hospital stay. These facilities offer services like physical therapy, occupational therapy, and medication administration. An IRF offers intensive rehabilitation services for patients requiring a higher level of therapy and medical supervision.

For Medicare to cover ambulance transportation to an SNF or IRF, the transfer must meet medical necessity requirements. This means the patient’s medical condition must necessitate ambulance transport because other methods would endanger their health. The patient’s need for observation or intervention by medical professionals during the transfer is a key factor. If the patient can be safely transported by other means, Medicare generally will not cover ambulance services.

A physician must document the medical necessity for ambulance transport. This documentation should indicate the patient’s condition requires professional medical observation or intervention during the transfer. While a physician’s order is important, it alone does not guarantee coverage; medical records must provide objective findings and clinical assessment data to support the need. Records should explicitly explain why alternative transportation is medically contraindicated.

For an SNF stay to be covered by Medicare Part A, the patient must have had a qualifying inpatient hospital stay of at least three consecutive days, not counting observation days. Admission to a Medicare-certified SNF must occur within 30 days of hospital discharge. Care must be for a condition treated during the hospital stay or a new condition developed while receiving SNF care. The patient must also require daily skilled nursing care or therapy services, typically provided seven days a week for nursing or at least five days a week for therapy.

For an IRF stay to be covered, a physician must certify the patient requires intensive rehabilitation, continued medical supervision, and coordinated care. Patients typically need to tolerate and benefit from at least three hours of intensive therapy per day, five days a week, or 15 hours within a consecutive seven-day period. The facility must conduct a pre-admission screening within 48 hours before admission to confirm eligibility and medical necessity. If the patient’s condition does not meet these criteria, or if they could safely be transported by a less costly method, Medicare will likely not cover the ambulance service.

When Transportation is Not Covered by Medicare

Medicare does not cover all transportation services. A primary reason for denial is when transportation is for convenience rather than medical necessity. If a patient prefers an ambulance over a less costly method, such as a wheelchair van or private vehicle, Medicare will not cover the cost. Coverage depends on the patient’s medical condition and the risk of alternative transport, not personal preference.

Transportation is also not covered if it is non-medically necessary. For instance, if a patient is mobile enough to sit in a car or wheelchair and does not require continuous medical monitoring, an ambulance service would not be covered. An ambulance must be the only safe means of transportation available for coverage.

Transfers to a facility that is not Medicare-certified or does not meet Medicare’s specific criteria for an SNF or IRF will typically not be covered. Medicare only pays for services provided by certified healthcare providers and facilities that adhere to its established standards.

If transport is solely for a non-medical purpose, such as a personal errand or social visit, Medicare will not provide coverage. The transport must be directly related to receiving a Medicare-covered service or returning from one. Even if the destination is a medical facility, if the underlying purpose is not medically justifiable, coverage will likely be denied.

Arranging Transportation and Exploring Payment Options

Arranging transportation from a hospital to a rehabilitation facility requires engaging with the hospital’s discharge planning team. Hospitals are required by Medicare to provide discharge planning for inpatients, including assessing post-hospital care needs and arranging safe transitions. Patients or their representatives should actively participate, communicating concerns and asking specific questions about transportation options and potential Medicare coverage. Inquire about documentation supporting the medical necessity of ambulance transport to ensure it aligns with Medicare’s criteria.

If Medicare does not cover transportation costs, alternative payment options and resources may be available. Medicaid, a joint federal and state program, can cover emergency medical transportation for eligible individuals. It may also provide coverage for non-emergency medical transportation to and from medical appointments. Eligibility and benefits vary by state, often including public transit, taxi services, or mileage reimbursement.

Private health insurance plans may also offer coverage for non-emergency medical transportation, especially if the transfer is for specialized services not available at the current facility and is medically necessary. Contact the private insurer directly to understand specific policy limits and requirements. Private insurance often acts as a secondary payer after Medicare, coordinating benefits to help cover remaining costs.

Many hospitals and healthcare facilities offer charity care programs to assist patients who cannot afford medical bills. These programs consider a patient’s income and assets and may provide free or discounted care, including transportation costs. Patients can inquire about these programs through the hospital’s billing or social services department.

Beyond traditional insurance, community resources and non-profit organizations provide medical transportation assistance. Organizations like Mercy Medical Angels or Patient AirLift Services arrange free or reduced-cost ground and air transport for patients needing to travel for specialized medical treatment. Local community services, often accessible through a 211 helpline, can connect individuals with volunteer driver programs, gas vouchers, or public transportation assistance. Foundations dedicated to specific diseases may also offer grants to help cover transportation expenses.