Job-based and Marketplace health plans
All Marketplace plans must cover 10 groups of benefits, called essential health benefits. Emergency services are one of them. Rides to regular doctor visits are not on that list.
That does not mean a plan never pays for a ride. Plans may cover other services beyond the required list. HealthCare.gov says that if you want to find out if a particular service is covered, call the plan.
Your plan’s Summary of Benefits and Coverage is a short, plain-language summary of what it covers. Insurance companies and job-based health plans must give you one. Look for words like “transportation” or “emergency medical transportation,” which HealthCare.gov defines as ambulance services for an emergency medical condition.
Car insurance after a crash
If you were hurt in a car crash, your auto policy may help with medical costs. Medical payments coverage and personal injury protection (PIP) pay for the treatment of injuries to you and your passengers. PIP is available in “no-fault” states. In a no-fault state, your own insurance company pays for injuries to you and your passengers no matter who caused the crash.
Some states include travel to treatment. In Michigan, the state insurance department says PIP can pay for transportation to and from medical appointments, which a Medicare policy usually does not cover. In New Jersey, the state rule defines PIP medical expenses to include reasonable and necessary expenses for ambulance services or other transportation, subject to limits in the policy.
Rules and limits can differ by state and by policy. Ask your insurer what your own policy covers.
Workers’ compensation for a work injury
If you were hurt on the job, your state workers’ compensation program may pay some travel costs to get treatment. Each state has its own workers’ compensation agency, and the rules can differ.
For example, Washington State’s Department of Labor and Industries (L&I) pays travel costs only if all of its rules are met. Your claim manager must approve it ahead of time. The provider must be more than 15 miles one way from your home (30 miles round trip), and there must be no provider within 15 miles who could treat your condition. You must also send a completed Travel Reimbursement Request (F245-145-000) with copies of all receipts. L&I may also pay for parking over $10, tolls and some other travel costs.
The U.S. Department of Labor keeps a list of every state’s workers’ compensation agency, so you can find the one for your state.
Federal employees hurt at work
Federal workers hurt on the job are covered by a federal program run by the U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP). OWCP has forms to ask for money back for travel to and from medical appointments.
Use form OWCP-957A if you are only asking for mileage. Use form OWCP-957B if you are asking for other travel costs. Mail the form to U.S. Department of Labor, OWCP/DFEC, PO Box 8300, London, KY 40742-8300.
CHIP for children
CHIP is the Children’s Health Insurance Program. Some states run CHIP as part of Medicaid. That kind of CHIP gives the same benefits as the state’s Medicaid plan for children, and federal Medicaid ride rules apply to it.
Other states run a separate CHIP program. Federal guidance says Medicaid ride rules generally do not apply to separate CHIPs, except those that provide the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. Separate CHIPs must still cover emergency services. Benefits vary by state and CHIP type, so ask your child’s CHIP plan whether it covers rides.
If you’re in Medicare hospice care
If someone is getting Medicare hospice care, talk to the hospice team before calling an ambulance. Once the hospice benefit starts, Medicare will not cover ambulance transportation unless the hospice team arranges it or it is not related to the terminal illness and related conditions.
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