Countless Americans get coverage from Medicare and Medicaid insurance alike. However, when it concerns covered transportation; both emergency and non-emergency transportation, very few people know about the differences pertaining to factors like availability and cost. According to the statistics of “Centers for Medicare & Medicaid Services”, more than 55 million Americans have Medicare coverage and more than 70 million have Medicaid coverage. Focusing on the difference of transportation of these two plans is equally important.
What are Medicare and Medicaid Programs?
Both Medicaid and Medicare are government programs, but the funding sources for both are different. Medicaid basically caters to the low-income groups and they rely primarily on funding from the state. This leads to varying coverage levels and rates of reimbursement by the state. Moreover, Medicaid usually covers fewer services as compared to other insurance sources. Medicare, on the other hand, is primarily a federal program designed for the aged population of the US, irrespective of their income and because this is a federal program, their billing and services are more consistent throughout the country (with minor adjustments depending on the difference in cost of living), especially when it comes to medical transportation.
How is Medicaid different from Medicare?
When it comes to transportation, Medicaid, however, seems to cover a lot more than Medicare. Medicaid pays for the eligible non-emergency transportation trips. These trips are meant for patients who can use a wheelchair or can walk and require a stretcher or an ambulance. On the contrary, Medicare will cover only the non-emergency trips, that too if a patient needs an ambulance.
What are the Differences in Reimbursement?
In Medicaid services, reimbursement typically varies by state, while in Medicare; reimbursement is consistent throughout the country and is always the same within the specified geographic regions. For instance, the ones providing transportation services in New Jersey can bargain with the transportation broker of the state. Due to this, Medicaid rates tend to vary from one transportation provider to another by location and over time.
On an average, the transportation providers under Medicaid are reimbursed by only 61% as compared to what Medicare will reimburse for one trip in the ambulance.
Role of non-emergency medical transportation
The non-emergency transportation helps you to book trips for patients with either Medicare or Medicaid making the payments. These service providers try to improve vehicle usage and improve routing and scheduling. Additionally, they attempt to help in alleviating the pressures handled by the Medicaid and Medicare transportation system.
What is the Medicaid coverage for Non-Emergency Medical Transportation?
Lack of transportation has always been a major barrier in accessing healthcare facilities, particularly for elderly people and disabled including low income group people. The federal Medicaid regulations, in order to address this issue, require the states to ensure that transportation is available from various providers. This is what's known as non-emergency medical transportation (NEMT). Though the scope of operations by NEMT includes a wide range of transportation solutions such as trips in buses, taxis, vans, and personal vehicles.
The various benefits of using non-emergency medical transportation include a hassle-free and timely visit to the doctor during a routine checkup or an emergency situation. Some states have also been approved from the Centers for Medicare & Medicaid Services (CMS) to waiver the benefit for the “new adult group that's made eligible under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) as part of their Medicaid expansion waivers.”
Further, the recent President's budget featured a proposal of changing NEMT benefits from a compulsory one to that of an optional one. States are further required to guarantee transportation by utilization of the best considered appropriate mode of transportation for the beneficiaries.
States should also provide assistance regarding the transportation of children and their families as part and parcel of Medicaid’s early and periodic screening, diagnostic, and treatment sessions. States have complete discretion about the type of vehicles and models for providing NEMT services.
As you think of the amount the Medicaid bears for NEMT trips, you should know that Medicaid pays primarily for the rides for eligible individuals and only for appropriate trips. This could be successfully used as a deterrent to fraudulent activities. This also includes wheelchair transportation services as these features have to be included in the NEMT.
Non emergency medical transportation services are mostly designed to be affordable so that people with disabilities, elderly people, and lower income individuals can manage their transportation expenses smoothly.