| Original Medicare (A/B) | Medicare Advantage (C) | Medigap (Supplement) | |
|---|---|---|---|
| Routine (non-emergency) NEMT | ✗ Not covered | Sometimes — supplemental benefit | ✗ Not covered |
| Emergency ambulance | ✓ Part B (80% after deductible) | ✓ Covered | Helps pay the remaining 20% |
| Your cost for routine rides | You pay privately | $0 up to a plan limit | You pay privately |
| How to get a routine ride | Pay privately — call DachiPlus | Check plan, then DachiPlus | Pay privately — call DachiPlus |
What does Original Medicare cover for transportation?
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). For transportation, it works like this:
- Emergency ambulance: Covered when you have a true medical emergency and other transport could endanger your health. Subject to Part B deductible and 20% coinsurance.
- Non-emergency ambulance: Covered only in narrow circumstances — typically when you're confined to bed and other transportation could endanger your health, with written documentation.
- Routine non-emergency transportation: Not covered. Trips to scheduled doctor appointments, dialysis, chemo, physical therapy, etc. are not a covered benefit under Parts A and B.
Does Medicare Advantage (Part C) cover non-emergency transportation?
Medicare Advantage plans are private insurance plans that replace Original Medicare. They must cover everything Original Medicare covers, but they can add supplemental benefits — and transportation is one of the most common.
Typical Medicare Advantage transportation benefits include:
- A set number of one-way trips per year (commonly 24–60 trips)
- Trips to plan-approved medical appointments and pharmacy visits
- Distance limits (often 25–50 miles per trip)
- Coordination through a designated transportation vendor
Benefits vary by plan and by year. Check your plan's Summary of Benefits or call your plan's customer service to confirm.
On Long Island, most Medicare Advantage plans route these rides through a transportation vendor such as Alivi (some plans use the GoMobile app for booking). The fastest way to use your benefit: call the member services number on the back of your insurance card and ask for "transportation benefits." They'll tell you your trip allowance and how to schedule.
What if I have a Medicare Supplement (Medigap)?
Medigap policies fill in gaps in Original Medicare. They generally do not add transportation coverage that Original Medicare doesn't already provide.
What if I have both Medicare and Medicaid?
If you have both Medicare and Medicaid (sometimes called "dual-eligible"), your Medicaid coverage typically handles routine non-emergency medical transportation. In New York, you'd book through MAS just like any other Medicaid member.
The test Medicare actually applies to an ambulance
Where Original Medicare does pay for transport, the standard is narrower than most people assume, and it is medical rather than logistical. The question is whether any other form of transport would endanger your health — not whether you have a car, whether anyone can drive you, or whether getting there is inconvenient. Being unable to drive, on its own, does not meet it. That is why a wheelchair van or ambulette trip is not covered by Part B at all, however necessary it plainly is: it is the wrong category, not an insufficient reason.
There is one route worth knowing about for recurring treatment. Where a patient genuinely requires stretcher-level transport on a repeating schedule — most often for dialysis — Medicare has a prior-authorisation pathway for repetitive scheduled non-emergency ambulance transport, supported by a physician's certification of medical necessity. It is a demanding standard and it is not a workaround for ordinary mobility needs, but for the small number of patients who meet it, arranging authorisation in advance is far better than discovering after the fact that a series of trips will not be paid.
Before you sign an Advance Beneficiary Notice
If an ambulance provider believes Medicare is unlikely to pay, they may ask you to sign an Advance Beneficiary Notice of Noncoverage. Understand what that form does before signing it: it is not a formality, and it does not ask permission to bill Medicare. It records that you were warned coverage may be denied and that you accept financial responsibility if it is. Signing it can be entirely reasonable when you need the trip and know the cost — but sign it knowing that is the trade, and ask what the charge will be if Medicare declines, while there is still time to consider an alternative.
What if my plan doesn't cover the trip I need?
You have several options:
- Private pay: DachiPlus offers transparent rates — see pricing.
- Other coverage: If your trip is related to a work injury or motor vehicle accident, workers' comp or no-fault auto may cover it.
- Long-term care insurance: Many LTCI policies cover transportation. See LTCI details.
How do I find out what my plan covers?
The fastest way is to call DachiPlus at (516) 754-7777 with your plan information. We verify coverage for you and tell you what's covered before booking the trip.