The key thing to know? There’s a difference between emergency and non-emergency transport. We’ll help you understand what’s covered and how to avoid denied claims.
Does Medicare Cover Ambulances?
Medicare covers ambulance services to the nearest facility that provides Medicare-covered services. But there are some common pitfalls that result in claims being denied (more below).
Ambulance services are covered whether you use Original Medicare (Medicare Part A and Part B) or Medicare Advantage. In certain situations, Medicare pays for approved non-emergency ambulance transport in certain situations as well. But, even when your ambulance ride is covered, you still need to pay your cost-sharing portion. And remember, this is for approved ambulance services only.
If your ambulance service isn’t for an approved scenario, you could be stuck with the full cost. Want to avoid an unexpected and hefty bill? Get clear on the details with your ambulance provider before any non-emergency transport.
Ready for a Medicare plan that works for you? Use the Insurify Medicare comparison tool to find Medicare plans near you. Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!
Which Ambulance Services Are Covered By Medicare?
Medicare covers emergency ambulance services to the nearest facility that provides Medicare-covered services. A medical emergency is defined by an urgent need to be transported to
for medically necessary services when any other means of transportation endangers your health.
Let’s look at some examples. If you break your ankle, you can likely be taken to the hospital by car or taxi without endangering your health. So an ambulance ride wouldn’t be covered.
By contrast, a stroke, heart attack, car accident, or major wound is a severe emergency. Traveling in anything other than an ambulance will endanger your health. Thus, Medicare covers your transport to the emergency room.
What if your local area does not have the facilities you need? Medicare covers transport to the nearest facility that provides the medical services you need.
For example, what if you live in a rural area and your nearest hospital can’t treat your emergency condition? Medicare will cover your ambulance ride to the closest appropriate facility. No matter the distance.
Remember: Medicare only covers emergency ambulance trips to the nearest appropriate medical facility. The facility must provide the necessary care you need. If you choose a facility that’s farther away, Medicare only pays the costs to take you to the closest facility. You will be responsible for the remaining cost.
Air Transportation and Medicare
Medicare coverage does include emergency air ambulance transport. That includes airplane or helicopter transport. But this is covered only if your health condition requires it. The criteria for covered air transportation are either that:
Your Cost for Ambulance Services
If Medicare covers your ambulance trip, you are responsible for two things. First, paying the rest of your Part B deductible. Second, paying the 20 percent coinsurance of the Medicare-approved amount.
In most cases, the ambulance company can’t charge you more than 20 percent of the Medicare-approved amount, plus any unmet Part B deductible. All ambulance companies must accept the Medicare-approved amount as payment in full.
In some cases, what you pay may be different. For example, if you’re transported by a critical access hospital (CAH) or an entity that’s owned and operated by a CAH.
Non-emergency Ambulance Transportation
Sometimes you’re not having an emergency but ambulance transportation is medically necessary. In such non-emergency situations, your ambulance transportation may be covered. But only if it’s necessary to treat your medical condition and any other transportation endangers your health.
To qualify for non-emergency ambulance service, you need a note from your doctor. The written order must state that ambulance transportation is necessary. Getting prior authorization from your insurer can help you avoid getting stuck with an unexpected bill.
If you’re confined to a bed (meaning unable to walk or sit in a wheelchair), you’ll likely qualify. You can also qualify if you need medical services only available in an ambulance setting. That can include monitoring or IV medication.
Medicare may also cover non-emergency transport if you have end-stage renal disease (ESRD). ESRD is permanent kidney failure requiring dialysis or a kidney transplant. Ambulance transportation to or from a dialysis facility is usually covered.
What if the ambulance company thinks Medicare may not cover the transport? The company is required to give you an “Advance Beneficiary Notice of Noncoverage” (ABN).
An ABN is a notice from a doctor, supplier, or provider before providing service when they believe Medicare might not pay. ABNs explain your payment responsibility. They also allow you to choose whether you want the service after you’ve been informed.
If you choose to accept the service and sign the ABN, you’ll be responsible for paying if Medicare doesn’t pay. The ambulance provider or supplier may ask you to pay at the time of service.
Ambulance Services That Aren’t Covered
Medicare will not cover ambulance services that are medically unnecessary. And they won’t cover transportation further than the nearest appropriate facility. For example, what if you don’t need helicopter transport, but take one anyway? Medicare will only cover the costs for ground ambulance. You’ll be stuck covering the difference.
Non-emergency or medically unnecessary transport from one facility to another isn’t covered either. Even if it’s to be closer to home or family.
Medicare never covers ambulette services. An ambulette is a wheelchair-accessible van that provides non-emergency transportation.
Medicare also doesn’t cover ambulance transportation when you lack access to alternative transportation.
What If Medicare Doesn’t Pay for My Ambulance Service?
If Medicare doesn’t pay for an ambulance trip that you think should be covered, you should do a few things. First, you or someone you trust should review your Medicare Summary Notice (MSN). You should also review any other paperwork related to your ambulance bill. You might find errors that can be fixed, such as:
The ambulance company didn’t fully document why you needed ambulance transportation. If this happens, you can contact the doctor who treated you or the discharge social worker. Get more information about your need for ambulance transportation. You can send this information to the company that handles bills for Medicare or ask your doctor to send it. Look on your MSN for the address
The ambulance company didn’t file the proper paperwork. If this happens, you can ask the ambulance company to refile your claim.
If refiling your claim doesn’t result in payment, you can file an appeal. To file an appeal:
1. Review your MSN. It will tell you why your bill wasn’t paid, how long you have to file an appeal, and what steps you need to take.
Follow the instructions on the MSN, sign it, and send it to the address of the company on the first page of the MSN. You may also include a letter explaining why the ambulance trip should’ve been covered.
Ask your doctor or healthcare provider for any information that may help your case. Attach copies to your signed MSN.
Be sure to keep a copy of everything you send to Medicare as part of your appeal.
If you need more information or help filing an appeal:
Visit Medicare.gov /claims-appeals/how-do-i-file-an-appeal
Call 1 ( 800) MEDICARE or TTY users call 1 (877) 486-2048
Call your State Health Insurance Assistance Program (SHIP). Contact information is available at shiptacenter.org or by calling 1 ( 800) MEDICARE
Your Medicare Will Cover Your A mbulance Ride If It’s Medically Necessary
Transportation is covered if any other transport endangers your health. If you’re having a medical emergency and need immediate care, call an ambulance.
Only in certain cases will your ambulance ride be covered in non-emergencies. If you’re having a non-emergency,be sure to call your insurer and ambulance company in advance. You want to know what’s covered and what costs you’ll be responsible for.
And don’t forget that the Insurify Medicare comparison tool is always here to help you. Find the best Medicare plan at the best price with just your ZIP code. Uncover plan options and compare them side-by-side. Try it today!
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