Health Tip
During the summer months, older adults are at a significantly increased risk for hyperthermia, the name for heat-related illnesses. Hyperthermia can include heat stroke, heat edema (swelling in your ankles and feet when you get hot), heat syncope (sudden dizziness after exercising in the heat), heat cramps, and heat exhaustion. The National Institute on Aging makes these suggestions for avoiding hyperthermia: 

Stay indoors on particularly hot or humid days.  
Drink plenty of liquids and wear light-colored, loose-fitting clothes in natural fabrics. 
If you do not have a fan or air conditioner, go somewhere else that is cool. A local senior center may provide a cooling center, or you can go to a public air-conditioned place like a mall, movie theater, or library.  
Look for symptoms of heat stroke, which include fainting, a change in behavior, dry, flushed skin with a strong and rapid pulse, and lack of sweating. If you believe someone is suffering from heat stroke, call 911.

Dear Marci,

I need some help getting to and from treatment I have schedule for next month. Will Medicare cover my scheduled transportation?

-Norman (Riverside, CA)

Dear Norman,

Depending on your circumstances, Original Medicare may cover scheduled/regular non-emergency ambulance transportation if the ambulance supplier receives a written order from your doctor in advance stating that transport is medically necessary. However, Medicare does not cover ambulance transportation just because you lack access to alternative transportation. The order must be dated no earlier than 60 days before the trip.

For example, if you are receiving dialysis treatments, Medicare may cover ambulance services to and from your home to the nearest dialysis facility, if other transportation could endanger your health.

Keep in mind that Medicare does not require a doctor’s written order for coverage of emergency ambulance transportation.

In certain states, ambulance suppliers must receive prior authorization from Medicare before providing scheduled, non-emergency ambulance transportation. These states include:

Delaware
District of Columbia
Maryland
New Jersey
North Carolina
Pennsylvania
South Carolina
Virginia
West Virginia
If the prior authorization request is approved, Medicare should cover your ambulance trips so long as the ambulance supplier also receives a written order from your doctor stating that transport is medically necessary. If Medicare denies your request, the ambulance supplier or you should submit a new prior authorization request. You have the right to appeal denials. Keep in mind that if you choose to receive services after a denial, you may be responsible for the full cost of your ambulance transportation.

If Medicare does not cover the kind of transportation you need, you may have other options. For example, Medicaid may cover some types of transportation that Medicare does not. Additionally, some Medicare Advantage Plans may cover additional types of transportation as a supplemental benefit. You can also contact ElderCare or your local State Health Insurance Assistance Program (SHIP) to learn about local resources that may be available to you.

I hope this helps!

-Marci

Dear Jiha,

Can Medicare help with transportation even if there’s no medical emergency? I’m hoping to better understand Medicare’s coverage of ambulance rides.

-Jiha (Baltimore, MD)

Dear Jiha,

Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by other means. If your trip is scheduled when your health is not in immediate danger, it is not considered an emergency.

Part B covers emergency ambulance services if:

An ambulance is medically necessary, meaning it is the only safe way to transport you
The reason for your trip is to receive a Medicare-covered service or to return from receiving care
You are transported to and from certain locations, following Medicare’s coverage guidelines
And, the transportation supplier meets Medicare ambulance requirements

To be eligible for coverage of non-emergency ambulance services, you must:
Be confined to your bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair)
Or, need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions

Medicare may cover unscheduled or irregular non-emergency trips, but if you live in a skilled nursing facility (SNF), a doctor’s written order may be required within 48 hours after the transport. Medicare may also cover scheduled, regular trips if the ambulance supplier receives a written order from your doctor ahead of time stating that transport is medically necessary.

Medicare never covers ambulette services. An ambulette is a wheelchair-accessible van that provides non-emergency transportation. Medicare also does not cover ambulance transportation just because you lack access to alternative transportation.

Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($226 in 2023). All ambulance companies that contract with Medicare must be participating providers. Note that if you are receiving SNF care under Part A, most ambulance transportation should be paid for by the SNF. The SNF should not bill Medicare for this service.

I hope this helps!

-Marci

The first day of summer is June 21. As UV intensity rises and we perhaps spend more time outdoors, it’s important to remember sun protection. The CDC recommends the following tips to protect your skin:

Stay in the shade when possible.
Wear clothing that covers your arms and legs.
Wear a hat with a wide brim to shade your face, head, ears, and neck.
Wear sunglasses to protect your eyes from eye diseases.
Use a sunscreen of SPF of 15 or higher.

Dear Marci,

I just learned about State Pharmaceutical Assistance Programs, or SPAPs. Can you tell me more about these programs and how they work?

-Jae (Durham, NC)

Dear Jae,

Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help residents pay for prescription drugs. Each program works differently.

States may coordinate their drug assistance programs with Medicare’s prescription drug benefit, Part D. This means that some SPAPs require that you sign up for Part D in order to qualify for assistance.

Your SPAP may help pay for your Part D plan’s:

Premium
Deductible
Copayments
Costs during the coverage gap, if one applies

If a drug is covered by both your SPAP and your Part D plan, both the amount you pay for your prescriptions plus the amount the SPAP pays will count toward the out-of-pocket maximum you have to pay before reaching catastrophic coverage.

Some states have qualified SPAPs. Enrollment in a Qualified SPAP gives you a Special Enrollment Period (SEP) that allows you to enroll in or make changes to your Part D or Medicare Advantage coverage outside of the the usual enrollment periods.

Check this list of State Pharmaceutical Assistance Programs to find out if your state has an SPAP, whether you are eligible, how the SPAP works, and how to enroll. You can also call your State Health Insurance Assistance Program (SHIP) to learn more about SPAPs in your state.

-Marci