Getting Your Parent to Medical Appointments: What Medicare, Medicaid and Home Health Will and Won't Do

Your dad gave up driving last spring. The cardiologist wants to see him in two weeks, across town, at 9:40 in the morning. You work. Your sister lives three states away. He says he'll "take a cab," and you both know he won't.

I'm an occupational therapist, and I've worked inside home health agencies. Getting into a car, out of it, through a parking lot and up to a front desk is a task like any other, and for many of my patients it was one of the hardest parts of the week. This guide covers what a national Medicare survey says about older adults and getting around, what Medicare, Medicare Advantage, Medicaid and PACE will pay for, and when home health can bring the care to the house so the trip isn't needed.

Below, a rule means a federal regulation or Medicare's own manual or handbook, and I'll quote it. Anything else is my own suggestion from working in the field, and I'll say so.

What the Survey Says

CMS runs the Medicare Current Beneficiary Survey every year. In 2026 it published 2024 figures on access to transportation. The survey covers people on Medicare who live at home, not in a nursing home. It doesn't track home health patients as a group.

Every question in this table is about trouble that comes "because of health or physical problem", in CMS's words. It isn't about owning a car. Every figure I use has a margin of error of about 2.5 percentage points or less, so I've rounded them.

The two groups that look most like home health patients are people 85 and older, and people who have difficulty with three or more daily activities. CMS counts six daily activities: bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating.

Source: CMS, 2024 MCBS Financial Well-being of Medicare Beneficiaries, Table 5, Access to Transportation.

Read the row about asking others for rides. Close to half of people 85 and older, and about two in three of those who have difficulty with three or more daily activities, ask others for rides because of their health. In my experience, that someone is usually a daughter, a son or a spouse who is also getting older.

The Closest Stand-In for a Home Health Patient

Neither column is a count of home health patients. Plenty of people who need help with bathing and dressing aren't on home health, and some home health patients are younger and recovering from surgery. Your parent may be in both groups at once. The survey tables don't combine the two, so I won't guess at a number.

People Who Also Have Medicaid

One more row is worth knowing. Among people with both Medicare and Medicaid, about 23% used a taxi or special transportation because of a health problem, against about 5% of people without Medicaid. The survey doesn't say who paid for those rides. My guess is that Medicaid's transportation benefit, below, is part of the reason.

What Original Medicare Pays For

Ambulances, and not much else. Medicare's handbook says: "Medicare covers ground ambulance transportation to a hospital, critical access hospital, rural emergency hospital, or skilled nursing facility for medically necessary services when traveling in any other vehicle could endanger your health" (Medicare & You 2027, p. 34).

The federal rule is stricter in wording. Medicare covers ambulance services "only if they are furnished to a beneficiary whose medical condition is such that other means of transportation are contraindicated" (42 CFR §410.40(e)(1)).

A planned ride by ambulance is possible in narrow cases. The handbook says: "In some cases, Medicare may pay for medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is medically necessary. An example of this could be someone with End-Stage Renal Disease (ESRD) who requires medically necessary ambulance transport to and from their dialysis facility." You pay "20% of the Medicare-approved amount," and "The Part B deductible applies" (Medicare & You 2027, p. 34).

For everyone who can ride in a car, Original Medicare doesn't pay for the ride. The handbook lists transportation among the things it calls non-medical long-term care. It says "Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don't pay for non-medical long-term care services" and that those services "may also include adult day heath care, personal care, transportation, home-delivered meals, and other home- and community-based services" (Medicare & You 2027, p. 58).

Home Health Won't Drive, but It Can Come to the House

Families often hope the home health aide can take Mom to her appointments. The rule says no: "The transportation of beneficiaries, whether to receive covered care or for other purposes, is excluded from home health coverage" (42 CFR §409.49(b)). Our guide to what home health does not cover goes through the other exclusions.

What home health can do is bring some of the care to your parent. If your parent qualifies, a nurse, a physical therapist, an occupational therapist, a speech therapist, an aide or a social worker comes to the house. The handbook says: "You pay nothing for covered home health services" (Medicare & You 2027, p. 46).

A blood draw is a common reason for a trip. On home health, the nurse can do it at home, with one catch. Medicare's manual says "venipuncture for the purposes of obtaining a blood sample can no longer be the sole reason for Medicare home health eligibility." But if your parent qualifies because of another skilled need, "medically reasonable and necessary venipuncture coverage may continue under a home health plan of care" (Medicare Benefit Policy Manual, ch. 7, §40.1.2.13).

Some doctor visits can happen by video. The handbook says: "Through December 31, 2027, you can get telehealth services at any location in the U.S., including your home." You pay "20% of the Medicare-approved amount," the same as for most in-person visits (Medicare & You 2027, p. 53). If your parent can't manage the call alone, sit with them. Our guide to patient portals and video calls has a quick way to check whether they can.

Starting home health doesn't always need an office visit either. Medicare requires a face-to-face encounter related to the main reason for home health, within 90 days before or 30 days after the start of care, and the rule says "The face-to-face patient encounter may occur through telehealth" (42 CFR §424.22(a)(1)(v)(B)).

When Every Trip Is a Major Effort

If getting your parent to appointments has become an ordeal, ask whether they're homebound. Being homebound is one of the requirements for Medicare home health. The handbook puts it in plain words. You're homebound if (Medicare & You 2027, p. 46):

• "You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury."
• "Leaving your home isn't recommended because of your condition."
• "You're normally unable to leave your home because it's a major effort."

The manual's full test has two parts. The first is needing "supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence", or having a condition that makes leaving "medically contraindicated." The second is "a normal inability to leave home" and leaving that requires "a considerable and taxing effort." Your parent needs one part of the first and both parts of the second (Medicare Benefit Policy Manual, ch. 7, §30.1.1).

Going to the doctor doesn't cancel it. The manual says: "Any absence of an individual from the home attributable to the need to receive health care treatment ... shall not disqualify an individual from being considered to be confined to his home." It names dialysis, chemotherapy, radiation and licensed adult day programs. A busy week is fine too: a patient "may leave the home (meeting both criteria listed above) more frequently during a short period when the patient has multiple appointments with health care professionals and medical tests in 1 week" (MBPM ch. 7, §30.1.1).

Two honest limits. Being old and not getting out much isn't enough on its own. The manual says "The aged person who does not often travel from home because of frailty and insecurity brought on by advanced age would not be considered confined to the home for purposes of receiving home health services unless they meet one of the above conditions." And homebound is only one requirement. Your parent also needs a skilled service, like nursing or therapy, ordered by a doctor or other allowed practitioner. Our guide to who qualifies for home health care covers the full list. Or answer the six questions below, checked against Medicare's own rules.

Medicare Advantage Plans

If your parent has a Medicare Advantage plan, rides may be covered as an extra. The handbook says: "Some plans may also cover things like rides to doctor visits, over-the-counter drugs Part D doesn't cover, and other health care. These benefits are generally limited, so check with the plan before you join to find out what exactly is covered and if these benefits are available to you." Some plans also offer "additional benefits customized to treat people with specific conditions and certain chronic illnesses", but "you'll need to wait until you join the plan to find out if you qualify" (Medicare & You 2027, p. 66).

Look in the plan's Evidence of Coverage, or call the number on the member card. My suggestion is to ask these questions, since a ride benefit can sound bigger on the phone than it is:

• How many one-way rides a year does the plan cover? Is a round trip one ride or two?
• How far will the ride go? Does it cover the specialist across town, or only within a set distance?
• How many days ahead do we have to book?
• Can a family member ride along?
• Is there a wheelchair van if my parent needs one?
• Who calls when the appointment runs long and the return ride has left?
• Does it cover the pharmacy or the lab, or only doctor visits?

Timing matters. "Beginning in 2011, the annual coordinated election period for the following calendar year is October 15 through December 7" (42 CFR §422.62(a)(2)(iii)). If rides are a big part of your parent's life, that's the window each year to compare plans for the year ahead. Our guide to Medicare open enrollment and home health covers what else to check before switching, and our guide to Medicare Advantage and home health explains how plans approve home health.

Medicaid

If your parent has full Medicaid as well as Medicare, rides are part of the deal. The handbook says: "People with full Medicaid coverage may get coverage for services that Medicare doesn't cover or only partially covers, like long-term care in a nursing home, personal care, transportation to medical services, home- and community-based services, home-delivered meals, and dental, vision, and hearing services" (Medicare & You 2027, p. 98).

Every state has to provide it. A state Medicaid plan must "Specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers" (42 CFR §431.53(a)). The rule's definition of travel expenses includes "The cost of transportation for the beneficiary by ambulance, taxicab, common carrier, or other appropriate means" and "The cost of an attendant to accompany the beneficiary, if necessary" (42 CFR §440.170(a)(3)).

A state may run these rides through a broker. The rule describes that service as being for people who "need access to medical care or services, and have no other means of transportation", using "wheelchair vans, taxis, stretcher cars, bus passes and tickets," and other means (42 CFR §440.170(a)(4)).

To book, call the number on your parent's Medicaid card, or the state Medicaid office. If your parent's Medicaid only helps pay Medicare premiums and cost sharing, ask the office whether rides are included before you count on them.

PACE

PACE, the Program of All-inclusive Care for the Elderly, is a Medicare and Medicaid program in some states for people who need nursing home-level care but live at home. Rides are built in. Medicare.gov lists "Transportation to and from the PACE center and medical appointments" among the services PACE may cover. To join, your parent must be at least 55, live in the service area of a PACE organization, need a nursing home level of care as certified by the state, and be able to live safely in the community with help from PACE. Medicare.gov also says: "If you have Medicaid, you won't pay a monthly premium for PACE."

It's a bigger change than adding a ride service. The rule says a participant "must receive Medicare and Medicaid benefits solely through the PACE organization" (42 CFR §460.90(b)), so the PACE team takes over your parent's care. Ask your state Medicaid office whether there's a PACE program near your parent.

Paratransit From the Local Bus System

If a public bus runs near your parent, the transit agency "shall provide paratransit or other special service to individuals with disabilities that is comparable to the level of service provided to individuals without disabilities who use the fixed route system" (49 CFR §37.121(a)). The rule calls it "origin-to-destination service" (49 CFR §37.129(a)): a ride from your parent's address, not a bus.

What to know before you apply:

• Who qualifies. Among others, someone "unable, as the result of a physical or mental impairment (including a vision impairment), and without the assistance of another individual ... to board, ride, or disembark from any vehicle on the system" (49 CFR §37.123(e)(1)). A temporary disability counts (§37.123(c)). Your parent has to apply first, so do it before the appointment, not the week of.
• Where it goes. At least to places "within corridors with a width of three-fourths of a mile on each side of each fixed route" (49 CFR §37.131(a)(1)(i)). Where there's no bus route, there's no paratransit requirement.
• Booking. The agency must provide a ride "at any requested time on a particular day in response to a request for service made the previous day", and may not make your parent leave "more than one hour before or after the individual's desired departure time" (49 CFR §37.131(b)).
• Cost. The fare "shall not exceed twice the fare" for the same trip by bus, and "A personal care attendant shall not be charged" (49 CFR §37.131(c)).

The Area Agency on Aging

States pass Older Americans Act money to local Area Agencies on Aging. The federal agency behind the program says the program pays for "Access to services such as transportation, case management, and information and assistance", and that local agencies "have the flexibility to use their funds to provide the supportive services that best meet the needs of older adults in their planning and service areas." So what's offered varies by county: volunteer drivers, a senior van, discounted taxi vouchers, or nothing.

To find your parent's local agency, call the Eldercare Locator at 1-800-677-1116 or go to eldercare.acl.gov (opens in a new tab). It's "a public service of the Administration for Community Living connecting you to services for older adults and their families."

How to Make the Ride Actually Work

This whole section is my suggestion, not a rule. It's how I'd look at it as an OT.

Practice the car. Getting in and out of a car is one of the hardest transfers there is. The seat is low, the door frame is in the way, and the ground is uneven. If your parent is on home health, ask the physical or occupational therapist to practice a car transfer with your actual car. Back up to the seat, sit, then swing the legs in together. A plastic bag on a cloth seat makes the swing easier. Take it off before driving.

Ask how far the driver will help. Some services wait at the curb. Some walk your parent to the door. If your parent can't manage the path from the front door to the car alone, find out before the driver is honking in the driveway.

Book the first appointment of the day if you can. Clinics run late as the day goes on. A long wait in a hard chair, and then a missed return ride, can wipe out the next two days for someone who tires easily.

Plan the way home first. Ask whether the return trip is booked at the same time, and what happens if the visit runs long. Keep the ride company's number in your parent's pocket.

Send the paper. Put a current medication list, the insurance cards and your phone number in one envelope that goes to every appointment. If nobody can ride along, call the clinic ahead and ask them to call you before your parent leaves.

Bundle the trips. If your parent needs the lab, the pharmacy and the doctor, ask whether the blood draw can happen at the office visit, or at home on a home health nurse visit, instead of a second trip.

If You Run an Agency

In this survey, about two in three people on Medicare who have difficulty with three or more daily activities asked others for rides, so many of your patients' appointments hang on a family member's work schedule. Ask who drives, and when, before you set visit times, and bring the local Area Agency on Aging and Medicaid transportation numbers to the first visit. In my experience, families ask about rides early and often.

Frequently Asked Questions

Does Medicare pay for rides to doctor appointments?

Original Medicare doesn't pay for routine rides. It covers an ambulance when traveling in any other vehicle could endanger your parent's health, and in some cases a scheduled non-emergency ambulance with a written order from the doctor. Some Medicare Advantage plans cover rides to doctor visits as an extra benefit. Full Medicaid covers transportation to medical services, and PACE covers transportation to the PACE center and medical appointments.

Will the home health nurse or aide drive my parent to appointments?

No. Medicare's home health rule says the transportation of patients, whether to receive covered care or for other purposes, is excluded from home health coverage. What home health can do is bring nursing and therapy to the house, so some trips aren't needed.

If my parent goes to the doctor, do they stop being homebound?

No. Medicare's manual says any absence from home to receive health care treatment doesn't disqualify someone from being homebound. That includes dialysis, chemotherapy, radiation and licensed adult day programs. A week with several appointments doesn't end homebound status either, as long as the person's overall condition still meets the rule.

Does my parent have to go to the doctor's office to start home health?

Not necessarily. Medicare requires a face-to-face encounter related to the main reason for home health, within 90 days before or 30 days after home health starts. The rule says that encounter may occur through telehealth.

How do I find a ride service near my parent?

Call the Eldercare Locator at 1-800-677-1116, or use eldercare.acl.gov, to reach the local Area Agency on Aging. If your parent has full Medicaid, call the state Medicaid office or the Medicaid plan. If a public bus runs near your parent, ask the transit agency about ADA paratransit. If your parent has a Medicare Advantage plan, check its Evidence of Coverage for a transportation benefit.

Sources

• 2024 Financial Well-being of Medicare Beneficiaries PUF, Table 5, Access to Transportation (CMS, Medicare Current Beneficiary Survey) (opens in a new tab)
• Medicare & You 2027 (CMS) (opens in a new tab)
• Ambulance services (Medicare.gov) (opens in a new tab)
• PACE (Medicare.gov) (opens in a new tab)
• Medicare Benefit Policy Manual, Chapter 7, Home Health Services (CMS) (opens in a new tab)
• 42 CFR §409.49, Excluded services (eCFR) (opens in a new tab)
• 42 CFR §410.40, Coverage of ambulance services (eCFR) (opens in a new tab)
• 42 CFR §424.22, Requirements for home health services (eCFR) (opens in a new tab)
• 42 CFR §422.62, Election of coverage under an MA plan (eCFR) (opens in a new tab)
• 42 CFR §431.53, Assurance of transportation (eCFR) (opens in a new tab)
• 42 CFR §440.170, Any other medical care or remedial care (eCFR) (opens in a new tab)
• 42 CFR §460.90, PACE benefits under Medicare and Medicaid (eCFR) (opens in a new tab)
• 49 CFR §37.121, Requirement for comparable complementary paratransit service (eCFR) (opens in a new tab)
• 49 CFR §37.123, ADA paratransit eligibility: Standards (eCFR) (opens in a new tab)
• 49 CFR §37.129, Types of service (eCFR) (opens in a new tab)
• 49 CFR §37.131, Service criteria for complementary paratransit (eCFR) (opens in a new tab)
• Senior Centers and Supportive Services for Older Adults (Administration for Community Living) (opens in a new tab)
• Eldercare Locator (Administration for Community Living) (opens in a new tab)