Does TRICARE cover non-emergency medical transportation? Ambulances, ECHO, and travel pay

TRICARE does not pay for rides to routine appointments. A family that wants a wheelchair van, a taxi or a medical transport cab for a regular visit has to look elsewhere, and the options are covered in what Medicaid transportation covers, Medicare and non-emergency rides and rides to VA appointments. TRICARE does pay in three situations: a medically necessary ambulance, travel to a specialist who is far from the enrollee’s primary care manager, and transportation to certain facilities under its program for family members with special needs. This page is for military families and the case managers who book their rides.

What TRICARE says about rides to the doctor

Routine rides are excluded outright. TRICARE’s ambulance page lists three exclusions: an ambulance used instead of a taxi when the patient’s condition would have allowed regular private transportation, transport to be closer to home, family, friends or a provider, and medical transport cabs for routine medical appointments. The regulation behind it, 32 CFR 199.4(d)(3)(v), says the same about vehicles such as medicabs or ambicabs, which function primarily as public passenger conveyances to and from medical appointments, with no medical care given in transit.

So a wheelchair van trip to a clinic visit is a private-pay or other-program trip, whatever the TRICARE plan. The family’s other coverage decides: Medicaid rides if the member has Medicaid, VA travel for an enrolled veteran, or a private-pay quote when nothing else applies.

When TRICARE pays for an ambulance

TRICARE covers medically necessary ambulance service connected to a covered condition. The regulation covers civilian ambulance service when it is medically necessary in connection with otherwise covered services and supplies and a covered medical condition. TRICARE’s page describes three uses: emergency transport to a hospital, transfers between medical facilities, and ambulance personnel treating a patient who is not taken to a hospital.

Three limits apply. The patient must go to the closest appropriate facility by the least costly means. A transfer made only to bring the patient nearer to home, family or a personal physician is not payable. Air evacuation is covered only when a land ambulance cannot reach the patient, the nearest facility is far away or blocked, and care is needed quickly (TRICARE air evacuation page). The regulation’s test is medical necessity, not emergency, so a scheduled stretcher trip can qualify when the patient’s condition rules out regular private transportation. TRICARE’s page, though, describes emergency uses. For a scheduled trip, such as a bedbound patient’s ride to a procedure, get the regional contractor’s answer before booking.

The Prime Travel Benefit: repayment for a distant specialist

TRICARE Prime and Prime Remote enrollees can be reimbursed for reasonable travel when their primary care manager refers them to a specialist who is too far away. The trip must be for medically necessary, nonemergency care that TRICARE covers. The patient cannot be an active duty service member, because active duty travel is handled by the member’s unit or, for Air Force members, a military hospital or clinic. Family members living with their active duty sponsor on orders in Alaska or Hawaii are left out too, and the primary care manager must be assigned in the United States. The distance depends on who the patient is, measured one way from the primary care manager’s office.

Two tests apply together: the referral is to a specialist beyond those distances, and no suitable specialty provider, military, network or non-network, is available within the same distance of the primary care manager. The benefit repays actual costs, not a flat rate. Mileage is paid for driving your own vehicle. Air and train travel are economy class, rental cars are compact class, and lodging and meals are capped at the government per diem for the specialist’s ZIP code. TRICARE asks travelers to call the Prime Travel office before booking airfare or traveling more than 400 miles one way, to confirm the most they can be repaid.

A non-medical attendant can travel on the same claim if the patient’s trip qualifies. The attendant must be a parent, spouse, other adult family member 21 or older, or a legal guardian, and for an adult patient the provider must confirm in writing that the attendant is medically necessary. Two travelers cannot claim the same expense, such as a shared hotel room.

The claim goes in within one year of the travel date, with the DHA 131 patient information form, the DD Form 1351 travel claim forms, itemized receipts, proof of attendance, any attendant letter and a direct deposit form. Credit card and bank statements are not accepted as receipts, and receipts must be dated within the approved travel dates. If a ride company is part of the trip, ask for an itemized receipt showing the date, pickup, drop-off and fare. TRICARE says to allow up to four weeks for payment.

ECHO: transport to a facility for a family member with special needs

The Extended Care Health Option pays for transportation only in a narrow case. The regulation limits it to an ECHO beneficiary receiving institutional care in a private nonprofit, public or state facility because the condition requires protective custody or residential training, and it covers a medical attendant when needed for safety (32 CFR 199.5(c)(6)). It does not cover everyday rides to clinics.

To use ECHO, the family member generally must be enrolled in the sponsor’s Exceptional Family Member Program, registered with a case manager in the TRICARE region, and approved in advance for each service. TRICARE says there is no retroactive registration for ECHO. Payment is the standard published fare, or the actual cost of specialized medical transportation when ordinary transport cannot meet the person’s needs or specialized transport costs less. Driving a private vehicle is repaid at the federal mileage rate on the date of travel.

All ECHO benefits together, other than ECHO Home Health Care, are limited to $36,000 per beneficiary per calendar year, and the family pays a monthly copayment set by the sponsor’s pay grade. The ECHO page lists $25 a month for E-1 through E-5 and $250 for O-10. Regional contractors handle registration: Humana Military in the East and TriWest Healthcare Alliance in the West.

When the family has more than one program

TRICARE For Life, Medicaid and VA each change who pays, and none adds a routine ride benefit to TRICARE.

• TRICARE For Life. It is Medicare-wraparound coverage. Medicare pays first, and TRICARE pays what remains for services both cover, so an ambulance trip that Medicare approves and TRICARE also covers is paid by both. Medicare allows an ambulance only when the patient’s condition rules out every other kind of transport (42 CFR 410.40(e)). Retirees on TRICARE For Life or Select with a verified combat-related disability, who have been awarded Combat-Related Special Compensation, can use the Combat-Related Disability Travel Benefit, which repays travel when no suitable specialist is within 100 miles of the primary care provider.
• Medicaid. TRICARE’s rule says it pays after all other health insurance except Medicaid, so TRICARE does not wait for Medicaid. CMS lets a state choose to cover Medicaid rides to services that another payer covers, with VA care as its own example (SMD 23-006). Whether a state does so is its decision, so ask the Medicaid ride line.
• VA. A veteran enrolled in VA health care has separate ride and travel pay options, covered in rides to VA appointments.

For a family caring for someone who needs a long-distance move or a flight, moving an elderly parent to another city compares the modes and who pays.

For the ride company a military family hires

A family paying a ride company out of pocket needs a dated, itemized receipt, so the ride company’s paperwork matters. HealthRide builds each invoice from completed trips, itemized trip by trip, and riders and families can pay by card through a payment link. See invoicing and payments.