Non-Emergency Medical Transport for Seniors
For many seniors, one of the hardest parts of aging is the loss of transportation. As you age, it becomes harder to safely drive, due to a decline in both vision and reflexes. Many seniors also find it harder to sit in a vehicle for long periods of time.
Fortunately, there are many services that help seniors remain independent even if they are unable to drive. One of the most important services is non-emergency medical transportation (NEMT), which provides transportation to medical appointments.
NEMT is provided through Medicaid. Many private insurance plans, including Medicare Advantage, also offer NEMT options. NEMT is a federally funded program, available throughout the United States. The program is managed on the state level. Each state must follow federal guidelines, but they have some flexibility in how the program is provided. NEMT vehicles are specialized to suit common senior issues, such as having a wheel chair lift and additional storage space for medical equipment.
Getting a Ride
Federal regulations state all Medicaid beneficiaries are eligible for NEMT, when necessary. The issue is each state sets different requirements for when NEMT is applicable. When you first enroll in Medicaid, you are told when your state does and does not allow NEMT. In many states, you must meet at least one qualifying condition. This includes not having a valid driver’s license or not owning a working vehicle. If you are unable to travel because of a physical, cognitive or mental disorder, you are also eligible for NEMT services.
If you have questions about whether you qualify for NEMT, you can contact a Medicaid caseworker to find the regulations for your state. If you are having trouble setting up a ride, you can also request the caseworker to speak on your behalf with the ride service.
Emergency vs. Non-Emergency
Another point of confusion regarding NEMT is what classifies as a non-emergency. This also causes issue with certain insurance plans. For example, Medicare offers limited coverage for emergency travel costs. Many Medicare beneficiaries see this clause and mistakenly believe it applies to NEMT.
A medical emergency refers to any event where your health is at serious risk if you do not get immediate treatment. This could be due to an accident or an existing medical condition. For example, if you suffer a heart attack or stroke, you require immediate emergency transport.
In comparison, non-emergency medical issue refers to any situations where you need to see a medical professional, but your health is not at risk if you do not go immediately. Setting up a doctor’s appointment because of a cold or joint pain is an example of a non-emergency.
An easy way to think about it is emergency transport refers to any medical transport you do not schedule, while non-emergency transport is for any services you set up in advance.
Costs of NEMT
How much coverage you receive depends on your insurance and where you live. In some states, Medicaid covers the entirety of NEMT costs. There may be exceptions, such as being charged a fee if you are late for your pickup. Depending on the state, your driver may be allowed to leave after a certain period of time if you do not show up. Another restriction may apply to who you get rides from. Each state has a different number of NEMT ride services. If your state has multiple programs, your insurance may only apply to one of the companies. If you are unsure what companies are covered under your insurance, you may speak either to your insurance or medical provider.
Depending on your state, there may also be additional charges if you require specialized car. With Medicaid, these charges are covered by your insurance. If you have a private insurance plan, you may be responsible for the costs. There may also be additional charges if you require additional transport, such as having to drive to a different facility for a test. Some companies also charge you if you change your appointment time. These companies normally waive the fee as long as the change is reported 24 hours before your scheduled appointment.
The exact cost for NEMT vary depending on state. Some states issue a flat fee for transport, typically between $25 to $30. This may increase on the weekends or during a holiday. If you need wheelchair service, the cost increases by $10 to $15. If your state charges based on mileage, it is normally between $3 and $5 per mile.
Other Forms of NEMT
NEMT is normally only available through your insurance provider. However, some state services also offer NEMT, even if you do not have insurance. There are also non-profit groups providing NEMT for seniors. You may also be able to get access to NEMT services as part of living in a retirement community or other senior living facility. If you are unsure what resources are available in your area, speak with your medical provider or contact the senior services department for your state.