Does Medicare Pay for Transportation to Chemotherapy?

For individuals undergoing chemotherapy, consistent access to treatment is important, making transportation a significant concern. Understanding how Medicare addresses these transportation needs can help alleviate financial burdens and ensure continuity of care. This article clarifies Medicare’s role in covering transportation expenses, detailing the various Medicare parts, eligibility criteria, and practical steps for securing coverage.

Medicare Parts and Transportation Coverage

Medicare, the federal health insurance program for people aged 65 or older and certain younger people with disabilities, is divided into several parts. Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). Part A generally does not cover transportation to outpatient chemotherapy appointments.

Medicare Part B covers emergency ambulance transportation when medically necessary. This includes situations where a patient’s health is in serious danger and they cannot be safely transported by other means. Part B may also cover medically necessary non-emergency ambulance transportation if a doctor provides a written order stating that other transportation methods could endanger the patient’s health. This can include transport to a Medicare-approved facility for services like chemotherapy or dialysis.

Medicare Advantage (MA) plans, also known as Part C, are offered by private companies approved by Medicare. These plans must cover all services that Original Medicare covers. Many Medicare Advantage plans offer additional supplemental benefits, including non-emergency medical transportation (NEMT). NEMT benefits can include transportation to routine doctor visits, pharmacies, and medical appointments, such as chemotherapy sessions. The specific types of transportation covered and the number of trips vary by plan.

Medicare Part D, which covers prescription drugs, does not provide transportation coverage. Individuals seeking transportation assistance for chemotherapy will primarily look to Medicare Part B for limited ambulance coverage or their Medicare Advantage plan for broader NEMT benefits.

Eligibility Requirements for Coverage

For Medicare to cover transportation to chemotherapy, specific eligibility criteria must be met, primarily “medical necessity.” Under Original Medicare Part B, an ambulance transport is medically necessary if the patient’s condition is such that using any other method of transportation would endanger their health. This means the patient cannot be safely transported by car, taxi, or wheelchair van without risking their health. A physician or other healthcare provider must provide a written order certifying this medical necessity.

Original Medicare’s non-emergency transportation coverage is generally limited to ambulance services. This includes ground ambulance and, in rare cases where ground transport is unsafe or too slow, air ambulance services. The transportation must be to the nearest appropriate medical facility capable of providing the necessary care, such as a hospital or a freestanding clinic for chemotherapy. Medicare typically does not cover transport to a physician’s office unless it’s an intermediate stop on the way to a covered destination for a dire medical need.

For Medicare Advantage plans, eligibility for NEMT benefits is determined by the specific plan’s rules. While many plans cover transportation to medical appointments, including chemotherapy, they often have limitations. These can include a maximum number of trips per year, mileage limits, or requirements to use specific transportation vendors. Some plans may require demonstrated need for transportation or may limit access based on medical necessity criteria, even for non-ambulance services.

Arranging and Submitting Claims

Once eligibility for transportation coverage is established, the next step involves arranging the service and ensuring claims are properly submitted. For Original Medicare Part B, the ambulance provider typically bills Medicare directly for covered services. The healthcare provider, such as the oncologist, must document the medical necessity for the ambulance transport, including a written order, before the service is rendered.

For repetitive, scheduled non-emergency ambulance services, such as regular trips for chemotherapy, a prior authorization process may be required. The ambulance company may need to submit a request to Medicare before the fourth round trip in a 30-day period, or if services are scheduled at least once a week for three or more weeks. This prior authorization helps ensure services comply with Medicare rules and can prevent claim denials. If prior authorization is not obtained and Medicare denies coverage, the beneficiary may be responsible for the full cost.

With Medicare Advantage plans, arranging transportation typically involves contacting the plan directly or their designated transportation vendor. Plans often require members to use in-network providers and may necessitate pre-authorization for NEMT services. Scheduling transportation in advance is advisable to ensure availability and proper authorization. Review your specific plan’s requirements to avoid unexpected costs.

Understanding Your Financial Responsibility and Other Options

Beneficiaries typically have financial responsibilities even when Medicare covers transportation services. For covered ambulance services under Original Medicare Part B, after meeting the annual Part B deductible ($257 in 2025), beneficiaries are generally responsible for a 20% coinsurance of the Medicare-approved amount. For example, if an ambulance trip has a Medicare-approved amount of $1,000 and the deductible has been met, Medicare would pay $800, and the beneficiary would owe $200.

Medicare Supplement (Medigap) plans can help cover these out-of-pocket costs, such as the Part B coinsurance and deductible, for services covered by Original Medicare. However, Medigap plans do not offer additional transportation benefits beyond what Original Medicare covers. If Medicare denies transportation coverage, beneficiaries have the right to appeal the decision. An Advance Beneficiary Notice of Noncoverage (ABN) may be issued by the ambulance company if they believe Medicare might not cover the service, informing the beneficiary of their potential financial liability.

When Medicare coverage is unavailable or insufficient, several alternative resources can assist with transportation for chemotherapy. Medicaid programs in many states offer non-emergency medical transportation (NEMT) benefits for eligible individuals, often with broader coverage than Original Medicare. Local non-profit organizations, cancer support groups, and hospital patient assistance programs frequently provide transportation services or financial aid to cancer patients. Community-based programs and some health systems may also offer ride services or vouchers for public transit to help patients access necessary medical care.