Start with the discharge planner
Hospitals that take Medicare must have a discharge planning process. Discharge planning means getting ready for the care you’ll need after you leave. You and your caregiver are part of the planning team.
The hospital must find patients who are likely to need help after they leave at an early stage of their stay. You, your representative or your doctor can also ask for a discharge planning evaluation.
This evaluation looks at what services you’re likely to need after you leave, and whether you can get them. A registered nurse, social worker or other qualified staff member must do it or oversee it. The results must be discussed with you or your representative.
Medicare’s discharge checklist suggests talking with the staff, like a discharge planner, social worker or nurse, throughout your stay. It also suggests talking to a social worker or your health plan if you have questions about what your insurance will cover.
When Medicare pays for an ambulance after a hospital stay
Original Medicare is the plan run by the federal government. Its Part B (Medical Insurance) covers ambulance rides to or from a hospital or skilled nursing facility, but only when other transportation could endanger your health.
Federal Medicare rules list the trip from a hospital to your home as one Medicare can cover. Your medical condition must be such that other ways of traveling are not safe for you.
A non-emergency ambulance ride may be appropriate if you are bed-confined, which means you can’t get out of bed without help, can’t walk and can’t sit in a chair or wheelchair. It may also be appropriate if your condition otherwise requires an ambulance.
Medicare may pay for a non-emergency ambulance if you have a written order from your doctor or other health care provider that says the ride is medically necessary.
If Medicare covers the trip, you pay 20% of the Medicare-approved amount after you meet the yearly Part B deductible.
Other rides home and Medicare plans
If you could travel safely another way, like by car or taxi, Medicare won’t cover an ambulance.
In a non-emergency, the ambulance company must give you a form called an Advance Beneficiary Notice of Noncoverage (ABN) if it believes Medicare may not pay. If you sign it and choose to get the ride, you’re responsible for paying if Medicare doesn’t.
Medicare Advantage Plans are Medicare plans sold by private companies. They must cover all medically necessary services that Original Medicare covers. Some plans may also cover rides to doctor visits as an extra benefit. These benefits are generally limited, so check with the plan to find out what is covered.
Medicaid may cover the trip
Federal rules require each state Medicaid program to make sure people with Medicaid have necessary transportation to and from providers. Each state decides how it meets this rule.
Some states allow ride requests on short notice when you leave the hospital. For example, North Carolina Medicaid says that for urgent pickups, like leaving the hospital or going to the pharmacy, you do not need to ask ahead of time. Rules in your state may be different.
For children under 21, federal guidance says that if a child needs someone with them, Medicaid must also cover that person’s trip. This includes round trips for admission and for discharge.
If you have Medicaid, call your Medicaid health plan or your state Medicaid office to ask how to book a ride home from the hospital.
Moving to a nursing facility or rehab
If you’re going from the hospital to a skilled nursing facility, rehab hospital or home health care, the hospital must give you a list of available Medicare-participating options in your area. The hospital must send your medical information to the place that will care for you next.
If you have a managed care plan, like a Medicare Advantage Plan, the hospital must tell you to check with your plan which providers are in its network.
Medicare covers an ambulance only to the nearest skilled nursing facility or hospital that can give you the care you need. Medicare does not cover an ambulance move to a facility just to be closer to home or family.
If you think you’re leaving too soon
Within 2 days of your admission and before you’re discharged, the hospital should give you a notice called An Important Message from Medicare about Your Rights. If you don’t get it, ask for it.
If you think you’re being discharged too soon, you can ask for a fast appeal. An independent reviewer called a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) will decide if your covered services should continue.
To ask for a fast appeal, follow the directions on the notice no later than the day you’re scheduled to leave. If you ask in time, you can stay in the hospital while you wait for the decision.
The BFCC-QIO is run for Medicare by Commence Health (formerly Livanta) or Acentra Health (formerly Kepro), depending on your state. You can also call 1-800-MEDICARE to get your BFCC-QIO’s phone number. If you’re in a Medicare Advantage Plan, different rules apply.
Getting ready for the day you leave
Ask where you’ll get care after you leave, and tell the staff what you prefer. Ask if you’ll need medical equipment, like a walker, and who will arrange for its delivery.
Medicare’s checklist suggests that a caregiver make sure they can give the help the person needs, and talk to the staff before discharge about getting that help.
A caregiver can also pick up prescriptions and run other errands before the person is discharged, to avoid extra trips.
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