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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.
The rules say that Medicare pays for transport only by ambulance. Ambulance vehicles must be designed and equipped to meet certain requirements. The vehicle must have emergency warning lights, sirens, communications equipment, a stretcher, linens, emergency medical supplies, oxygen equipment and other life-saving equipment. The vehicle also must be staffed with two people, one of whom is certified as an emergency medical technician. Medicare will not pay for transport by vehicles that do not meet these requirements. You can find this rule at 42 CFR Sections 410.41(a). The rules say that Medicare will pay for durable medical equipment that is mainly used to serve a medical purpose. Items such as hospital beds, respirators, wheelchairs and crutches are examples of equipment that are clearly used for medical purposes. Medicare will not pay for: 1. Equipment that is primarily and customarily used for nonmedical purposes. Examples include air conditioners, humidifiers, dehumidifiers and electric air cleaners; 2. Equipment used for a patient's comfort or for the convenience of a person caring for the patient. Examples include elevators, stairway elevators, physical fitness equipment and self-help devices such as grab bars. You can find these rules in the Centers for Medicare and Medicaid Services, Internet Only Manual, Medicare Benefit Policy Manual, Chapter 15, Section 110.1.
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.
The Plan contract says that the Plan covers items and services in accordance with Medicare rules. The Plan contract says that if you are diagnosed with the following chronic condition(s) identified below and meet certain criteria, you may be eligible for special supplemental benefits for the chronically ill. You can find this information on page 64-65 of the plan's 2021 Evidence of Coverage. The health plan contract says that if you have been diagnosed by a qualified provider with certain chronic conditions and you meet certain criteria, you may be eligible for additional benefits. Additional benefits include: A quarterly allowance for healthy food purchases and/or for help with your electricity, water, phone, Internet and/or gasoline payments. The allotted amount by the plan is to be used in combination for these services. This is a maximum amount allowance to combine the six (6) services mentioned above. The Plan will cover up to a maximum amount of money quarterly. Once that maximum amount is reached, the benefit will not be available until the next quarter. Unused allowance amount cannot be carried over to the next quarter. The quarterly periods are from January to March; from April to June; from July to September; and from October to December.
If the service you receive exceeds the quarterly amount allotted by the plan, you must pay the difference in price, if any.
You can find this information on page 99 of the plan's 2021 Evidence of Coverage.