Does Medicare Cover Ambulance Services?

Medicare covers ambulance services and transportation when you experience a medical emergency or when you need qualifying ambulance transportation to a health facility.

Original Medicare (Part A and Part B) and Medicare Advantage (Medicare Part C) plans cover ambulance services during an emergency when you need immediate access to a hospital for vital health care.

Eligibility Requirements for Medicare Ambulance Coverage

Medicare Part B may cover ambulance services when other transportation could endanger your health. To be eligible for coverage, you must have a doctor's order and meet certain criteria.

• Medical necessity
  Medicare covers ambulance services only if they are deemed medically necessary by a healthcare professional. In these cases, using any other form of transport could be hazardous to your wellbeing.
  
  
• Doctor's order
  Medicare may sometimes may pay for medically necessary non-emergency ambulance transportation. In most cases, you'll need a written order from your doctor stating that an ambulance ride is required due to medical necessity.
  
  
• Location of facility
  Medicare will cover transportation to the nearest appropriate medical facility capable of providing the skilled medical treatment you require. This includes hospitals, skilled nursing facilities (SNFs), and critical access hospitals (CAHs). 
  
  If you choose to be transported elsewhere at your request or convenience, additional costs may not be covered by Medicare.

Medicare Advantage plans cover everything Original Medicare covers, and some plans may cover other ambulance services not covered by Original Medicare. Learn more about Medicare Advantage plans and the extra benefits some of these plans may offer.

It's also worth mentioning that some requests for Medicare to cover ambulance transportation are occasionally denied. If a beneficiary feels their Medicare coverage has been denied in error and the Medicare beneficiary's transportation meets Medicare guidelines, they can appeal the decision by following the instructions on their Medicare Summary Notice.

What Ambulance Services Does Medicare Cover?

Medicare Part B covers a variety of ambulance services. 

The primary type of transportation covered is ground ambulance, which transports you to the nearest appropriate medical facility capable of providing the required treatment. This includes hospitals, skilled nursing facilities, and critical access hospitals.

In certain cases where ground transportation could endanger your health or when your location is not easily accessible by road, Medicare also covers air ambulance services. These include both fixed-wing aircraft (airplanes) and rotary-wing aircraft (helicopters). 

Remember that non-emergency medical transportations are typically not covered unless they meet strict requirements outlined by Medicare. If you have a Medicare Advantage plan, be sure to ask your plan carrier about transportation coverage details, such as whether there is a preferred ambulance company for members to use.

How Much Does Medicare Pay for Ambulance Services?

Typically, Medicare Part B pays 80% of the approved amount for medically necessary ambulance transportation after you have met your annual deductible. The remaining 20% is your responsibility as a beneficiary.

The Medicare-approved amount varies depending on factors such as the level of service provided (e.g., basic life support or advanced life support) and whether it's an emergency or non-emergency situation. To give you an idea, here's a breakdown of potential costs:

• Part B deductible: In 2023, the annual Part B deductible is $226.
• Part B coinsurance/copay: After you meet your Part B deductible, you're typically responsible for a 20% Part B coinsurance.

For example, if Medicare approves $1,000 for your ambulance ride after you meet your Part B deductible, Part B will cover $800 (80%), leaving you responsible for paying $200 (20%).

If you're enrolled in a Medicare Advantage plan, your coverage may differ from Original Medicare, so it's important to review your plan details.

Conclusion

Medicare coverage for ambulance services can be a lifesaver for seniors who need emergency care or skilled medical treatment. 

The amount that Medicare covers can depend on whether the transport is considered an emergency or non-emergency situation and if it was ground or air transportation. In general, Original Medicare pays 80% of the Medicare-approved amount while beneficiaries are responsible for paying the remaining 20%.

Call to speak with a licensed insurance agent today to learn more about Medicare and to find out if Medicare Advantage plans available where you live cover additional ambulance benefits not covered by Original Medicare.