Medicare covers the following types of ambulance services: 1. EMERGENCY GROUND (vehicle) When is it provided? After you have had a sudden medical emergency, when your health is in serious danger, when every second counts to keep your health from getting worse, and when other transportation could endanger your health. For example, severe pain, shock, bleeding or unconscious. What conditions do I have to meet? Coverage depends on the seriousness of your medical conditions and whether you could have been safely transported some other way. 2. NON-EMERGENCY GROUND When is it provided? When you need transportation to diagnose or treat your health condition and transportation in any other vehicle would endanger your health. For example, you are confined to your bed and you need to be transported to get dialysis treatments. What conditions do I have to meet? In some cases, you must have orders fro your doctor or other health care provider saying that ambulance transportation is necessary because of your medical conditions. 3. EMERGENCY AIR (airplane or helicopter) What is provided? If your health condition requires immediate and rapid ambulance transportation that ground transportation can’t provide. Example: life threatening car accident. What conditions do I have to meet? You must have a condition that requires immediate and rapid ambulance transportation that ground transportation can’t provide. Medicare pays 80% of the Medicare approved amount after you meet the yearly Part B deductible. Other criteria may apply. For more detailed information visit www.medicare.gov to view the booklet, “Medicare Coverage of Ambulance Services.”
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Daily Kos: A Medicare voucher by any other name, still a bad deal for seniors
Proposals floating around Congress these days call for privatizing Medicare via vouchers, but they don’t use the term. In general, the proposals would encourage insurance companies to bid against each other, to produce the lowest-cost policies in the private market. Customers would receive a sum of money—aka a voucher— to help defray the cost. Tennessee Sen. Bob Corker introduced his “Dollar for Dollar Act,” and a good chunk of it deals with what he calls structurally transforming Medicare by “keeping fee-for-service Medicare in place, competing side-by-side with private options that seniors can choose instead. Utah Sen. Orin Hatch used the term “competitive bidding” and said allowing health plans “to compete with traditional fee-for-service Medicare” would reduce costs and preserve the quality of care. The plans would allow people to choose between these voucherized plans and traditional Medicare, preserving the notion of choice. Foes of our social insurance programs have gotten savvy enough to realize that they can’t privatize Medicare in one fell swoop, as Ryan’s original budget (back before “vouchers” were a dirty word) envisioned. So in the next iteration, they employed the idea of “choice,” of competition with traditional Medicare. That allows them to chip away at it, pulling away younger, healthier patients who might be able to get good private insurance deals and leaving the older, sicker, more expensive patients in traditional Medicare to sap the program more quickly and make killing it off entirely that much easier.
Medicare Coverage and Home Healthcare
Medicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). In 2011, Medicare covered 48.7 million people. Total expenditures in 2011 were $549.1 billion. Learn more about the differences between Medicare Part A, Part B, Part C and Part D.
Part VIII: Medicare Skilled Nursing Coverage
Skilled care will assist you in getting better, living independently and understanding how to take care of your health. Skilled nursing care is necessary to either help improve your condition, or maintain your condition and keep it from worsening. Rehabilitation care is necessary when you want to improve your condition within a period of time, or you wish to set up a remedial program that maintains your condition and keeps it from worsening. You have to choose your own Medicare-certified SNF.
Medicare Coverage: Does Medicare Pay for Ambulance Service?
Most people want to know if their Medicare coverage will cover ambulance service long before they are even put onto a stretcher and wheeled into such a vehicle. In fact, most people do not worry about whether or not their insurance policy will pay for any of the cost of being transported in an ambulance until well after they have received needed treatment and have found themselves swallowed up by a month of bills. A person’s Medicare coverage may pay for ambulance services as long as certain conditions are met. A person must have original Medicare for the information listed below to apply to them.
NRC Capitol Clips: New Federal Rule Addresses Medicaid Transportation
This rule concerning “benchmark” plans in Medicaid takes effect July 1, 2010. States’ requirement to assure non-emergency medical transportation is nothing new; that has been in place for many years, first as a result of federal court cases, and then as a matter of CMS regulation. Now that medical transportation providers may be feeling some level of justified comfort that their services are not going to be ended (that was a very real fear in response to CMS’ initial proposals on this rule), there are some points of this latest rulemaking that bear careful consideration. 1. “Benchmark” plans are an option that is available to states. There is no requirement that states adopt this optional approach to elements of their Medicaid programs. However, CMS estimates that 90 percent of states will have some form of benchmark programs in place within a year or two. Given the nature and scope of the newest federal health legislation, that number is probably too low, and it’s much more likely that nearly every state will have some form of benchmark-like coverage in their Medicaid programs in the near future. Therefore, anyone who’s trying to set up systems for the future implementation of Medicaid should read more of today’s rule, and see how CMS is beginning to instruct states in their relations with insurance companies, managed care organizations, and other intermediaries. 2. The rule on benchmark plans has some reminders that CMS has an option by which states can provide Medicaid transportation through a brokered program (defined by regulation at 42 CFR Section 440.170(a)(4), in which case these transportation expenses can be covered as “medical services” (and thus reimbursed by CMS at the state’s Federal Medical Assistance Percentage rate, instead of the fixed 50 percent reimbursement for Medicaid program administrative costs) even if certain requirements for medical services (such as patient freedom of choice) are not part of the “brokerage.” As with the benchmark program, it is very important to remember that such Medicaid transportation brokerages are an option available to states; they are not required. 3. For the first time that I’ve ever noticed, the benchmark rule has a requirement for public participation in Medicaid planning. It’s a narrow window, and simply requires states to solicit public comment if they are preparing a state Medicaid plan amendment in pursuit of creating a benchmark program. Maybe there’s always been a requirement for public input; if so, it may be something to be more aggressively publicized. 4. In case people hadn’t been following this trend, in both the previous and current presidential administrations, CMS is having options and features of Medicaid being addressed by states through Medicaid plan amendments, and not through waiver requests. Although Medicaid planning is nothing at all like transportation planning, the fact that more process-driven approaches are being dictated by the federal government may give more opportunities for meaningful involvement by stakeholders as states pursue their Medicaid strategies. 5. And for those people who follow federal interagency coordination policies, there is this verbiage, as it appears in the CMS rulemaking notice: “We do not believe that Executive Order 13330, which relates to the coordination of transportation among Federal agencies, is relevant to this rule.”