Moving an elderly parent to another city: stretcher van, a flight with a companion, or air ambulance

Start with how your parent travels today

How your parent manages an ordinary day decides how they can travel a long way. Before you call anyone, settle four questions with your parent and their doctor:

• Can they sit upright? On an airline flight, everyone on board must be in an approved seat or berth with a safety belt fastened while the plane taxis, takes off, and lands. A parent who cannot stay upright in a seat that long needs a stretcher, and airlines do not have to offer one.
• Can they transfer out of the wheelchair? With some help, a parent who can shift into an aircraft seat can fly. A parent who must stay in their own wheelchair the whole time cannot, because every passenger rides in an aircraft seat and the wheelchair goes in a cabin closet or the cargo hold.
• Do they use oxygen? Work out how long the whole trip takes, door to door, plus a margin for delays. That number decides whether a portable concentrator and batteries will cover a flight, or how many tanks a van must carry.
• Is their condition stable? A parent who needs monitoring, IV medication, or a nurse’s care on the way needs a medical crew, which a van or an airline seat does not provide.

Ask the doctor to put the answers in a short note. A written answer helps when an airline, a ride company, or the new facility asks the same questions.

Driving the whole way in a wheelchair or stretcher van

A van suits a parent who cannot fly, cannot sit in an airplane seat, or needs to stop often. In a wheelchair van your parent stays in their own chair, secured to the floor, for the whole trip. In a stretcher van they ride lying down on a cot locked into the vehicle. Our guide to stretcher transport cost explains why the stretcher option costs more.

A trip of several hundred miles takes planning that a local ride never does:

• Drivers. Ask whether one driver will cover the whole distance or two will trade off, and where the van will stop overnight if it stops at all.
• Breaks. Your parent will need meals, medication on schedule, and toilet breaks. Ask how the crew handles each one for a rider who cannot walk.
• Overnight stays. If the trip stops for the night, confirm that the hotel room is accessible and whether the crew helps your parent in and out.
• A companion. Ask whether a family member can ride in the van, and book the seat.
• Arrival time. Line up the arrival with the hours the new facility admits residents, or with someone being home to let your parent in.

Check the company before you pay a deposit

A company paid to carry passengers across state lines needs a USDOT number and federal operating authority, no matter how small its vehicles are, unless an exemption applies. Federal rules also set a floor for its public liability insurance: $1.5 million for any vehicle that seats 15 or fewer people, counting the driver. FMCSA’s free Company Snapshot lets you search by DOT number, MC number, or company name, and it shows the company’s safety rating if it has one, a summary of roadside inspections that put vehicles or drivers out of service, and reported crashes.

Ride companies price long trips from miles, crew hours, tolls, and lodging, and our guide to long-distance medical transportation pricing walks through how a quote is built. The operator’s side of crossing state lines is in our guide to out-of-state NEMT trips.

Flying with a companion

A commercial flight is often the fastest choice for a parent who can sit upright and transfer to a seat with help. The federal Air Carrier Access Act rules set what airlines can and cannot ask of a traveler with a disability.

Medical paperwork

An airline may not demand a medical certificate as a condition of travel except in a few cases: a passenger traveling on a stretcher or in an incubator, one who needs medical oxygen during the flight, or one whose condition leaves reasonable doubt that they can finish the flight safely without extraordinary medical help. In those cases the airline can require a written statement from the doctor, dated within 10 days of the first departing flight. Under the rule’s own example, the same note covers a return flight months later.

Oxygen

Airlines do not have to supply in-flight oxygen, so plan on a portable oxygen concentrator. U.S. airlines must allow one on planes originally designed with more than 19 passenger seats, as long as it carries a label showing it meets FAA requirements or is one of the models the rule names. The airline may require your parent to:

1. Call 48 hours before departure to learn the longest expected flight time.
2. Check in up to one hour before the general check-in deadline.
3. Bring enough fully charged batteries for at least 150 percent of that flight time.
4. Show a physician’s statement at the airport.

Who helps on board

Flight attendants are not required to help with eating, help in the lavatory or with toileting at the seat, or give medical care. That is the companion’s job. An airline can require a safety assistant in four cases: a passenger on a stretcher, one who cannot understand or respond to safety instructions because of a mental disability, one who cannot physically help with their own evacuation, and one with both severe hearing and severe vision loss who cannot set up a way to communicate with the crew. If the airline insists on an assistant for any reason other than a stretcher, against your parent’s own judgment that they can travel alone, it may not charge for the assistant’s seat, though it does not have to find the person. A companion your parent chooses to bring when the airline did not require one can be charged a normal fare. A need for help with eating or toileting alone is not grounds for requiring an assistant.

Stretcher seating on a commercial flight is an optional service under the rule, and an airline that offers it may ask for 48 hours’ notice. Plan ground rides at both ends as carefully as the flight. Our guide to airport transportation for wheelchair users covers curbside drop-off, airline assistance from the terminal to the gate, and timing pickups around delays.

Air ambulance, when your parent needs care on the way

An air ambulance is a helicopter or airplane fitted as an ambulance, with a medical crew. It is the choice for a parent whose condition would be put at risk by hours in a van or a commercial seat.

It is also the most expensive option. GAO’s March 2019 report, based on 2017 claims for privately insured patients, found median charges of about $36,400 for a helicopter transport and $40,600 for a fixed-wing flight, and about 69 percent of those transports were out of network. GAO cautioned that its data set may not represent all private insurers.

Those figures predate the federal surprise billing rules. For plan years starting in 2022 or later, when a private health plan covers air ambulance services, an out-of-network air ambulance company may not bill the patient more than the plan’s in-network cost sharing. That protection does nothing for a flight the plan does not cover, which is why a planned move needs a written quote and the plan’s written answer on coverage before the flight.

What Medicare and Medicaid will pay for

Medicare

Medicare pays for ambulance service, by ground or air, only when your parent’s condition makes other transportation unsafe. One way a non-emergency trip qualifies is a parent who is bed-confined: unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair, with records showing other transport would be unsafe. A parent who is not bed-confined can still qualify when their condition requires an ambulance.

The destination rules limit long trips:

• Nearest facility. The trip must go to the nearest hospital, critical access hospital, rural emergency hospital, or skilled nursing facility that can give the care needed, or from such a facility back to your parent’s home.
• Local transport. Medicare’s benefit manual says only local ambulance transportation is generally covered, so mileage is paid only to the nearest appropriate facility.
• Family preference. For air transfers between hospitals, the manual says coverage is not available because the patient or family prefers a specific hospital or physician.

A move across the country to be near family does not meet those rules. Medicare may still cover care once your parent arrives.

Medicaid

Medicaid rides exist to reach covered care, and CMS draws a firm line: when a member leaves one home in the community for another because they want to live near relatives or friends, the ride is not covered. In the same passage, which sits in its guidance on disasters, CMS says a state must cover a move from one nursing facility to another, or from a nursing facility to a community setting, when the move is needed to keep receiving services, even when the new placement is in another state.

A state’s Medicaid program also pays for care its members get in another state in four situations:

1. A medical emergency.
2. Care the member needs while away, when making them travel home first would put their health at risk.
3. Care the state decides, on medical advice, is easier to get in the other state.
4. Care in a place where people in that area normally use the other state’s medical resources.

Our guide to Medicaid lodging and meals for medical travel covers the out-of-town expenses on those trips.

Which state’s Medicaid covers your parent after the move

An adult on Medicaid is a resident of the state where they live and intend to stay, and no state can make a new resident wait a set period before qualifying. So your parent usually applies in the new state after the move.

Facility placements follow a different rule. If a state agency arranges your parent’s placement in a nursing home in another state, the state that arranged it remains the state of residence. The rule treats anything beyond giving the family information as arranging, though helping a parent who chose to move on their own find a facility does not count. Ask the hospital discharge planner or Medicaid caseworker which state will be paying before your parent leaves.

Get it in writing before moving day

1. The quote. Total price, what it includes (driver time, tolls, lodging, a second crew member), the deposit, and the cancellation terms.
2. The vehicle and crew. Wheelchair or stretcher van, how many drivers, and whether a second crew member rides for the whole trip.
3. The route. Departure time, any overnight stop, and the expected arrival time.
4. The receiving end. The new facility’s written confirmation of the admission date and time, or the name of the person who will be home.
5. The carry bag. A medication list and enough doses for the trip plus a spare day, the oxygen prescription and supply, recent medical records, copies of advance directives, and insurance cards.
6. The company’s credentials. The USDOT number for an interstate trip, checked on FMCSA’s Company Snapshot.

If someone in the family cannot ride along, ask the ride company how you will hear when your parent is picked up and dropped off. Some families also hire a medical escort to make the trip, and our guide to medical escorts for seniors covers what they do and cost.

For the companies that drive these trips

Long trips cross stretches of highway with no signal. HealthRide’s driver app keeps working without cell service, signatures are captured on screen, and the GPS miles and route driven are saved on every trip. Families can follow the driver live from a text link. See the driver app.