Does Medicare Cover Ambulance Services?
Medicare covers ambulance services under Part B when they are medically necessary. To qualify, the patient’s condition must require immediate medical attention that cannot be safely provided by other means of transportation. Ambulance services are considered necessary when the patient’s condition requires the specialized skills and equipment available only in an ambulance.
The transportation must be between the patient’s residence and a Medicare-covered destination, such as a hospital or skilled nursing facility. Factors such as the distance to the nearest appropriate medical facility and state or local regulations may also influence coverage.
Read on to learn more about the types of ambulance services, how Medicare may cover the costs, the role of Medicare Advantage in ambulance coverage, and what an ambulance ride may cost you with Medicare coverage.
Table of Contents
What Is Ambulance Transportation?
Ambulance transportation is the direct transport of a patient to the nearest facility that can provide the care they need. For example, an ambulance ride may be your safest option if you are seriously injured in a car accident or fall and break multiple bones.
There may also be non-emergency situations for ambulance transportation. One example is if you have End-Stage Renal Disease (ESRD). Because this disease causes permanent kidney failure, ongoing dialysis is needed to keep patients alive. As a result, even a scheduled visit to the hospital or other medical facility may require the use of an ambulance to ensure dialysis is not interrupted.
Types of Ambulance Services
The four most common types of ambulance services include:
- Ground ambulances: Ground ambulance transportation is used in cases of a severe medical emergency, such as an injury due to a car accident, burns due to a house fire, or other life-threatening conditions. It’s often best suited for urban areas where road systems allow ambulances to quickly and easily reach patients.
- Air ambulances: Air ambulance services include planes and helicopters, used in cases of significant injury or serious illness requiring immediate and rapid transportation. They may also be required if you are in a remote location that’s not easily accessible by ground ambulance. For example, if you’re camping in an area that’s not passible and you could seriously injure yourself by traversing it, an air ambulance may be the best way to get you the help you need.
- Water ambulances: Water ambulances may be used when you require emergency transport in areas where boats are the most efficient mode of transportation. This might include situations where you’re injured at a family cabin on an island or stranded on a boat in the middle of a large lake or sea.
- Non-emergency ambulances: Non-emergency ambulance services may also be used in some situations. One example is ESRD. In other cases, physicians may request non-emergency ambulance transportation (NEAT) for patients if they meet certain conditions, such as spinal cord injuries that limit their mobility or mental health issues that make patients a danger to themselves or others.
How Does Medicare Cover Ambulance Rides?
Ambulance rides are covered under Medicare Part B. If Medicare approves your ambulance ride, you pay 20% of the Medicare-approved amount after you have met your Part B deducible. Medicare pays the remaining 80%.
There are possible exceptions to this coverage. For example, if you are transported by an ambulance owned and operated by a critical access hospital (CAH), these payment amounts may differ. Every three months, you’ll receive a Medicare Summary Notice (MSN) in the mail listing the services billed to Medicare, including ambulance trips. You can also log into your Medicare.gov account to access this information. If Medicare denies your ambulance trip, the MSN will include information explaining why.
Medicare beneficiaries can only use ambulance services to go to their nearest medical facility. Medicare may also pay for limited services, like non-emergency ambulance transportation, if the beneficiary has a doctor’s written order stating that it is a medically necessary ambulance transport. For example, a patient with ESRD may need non-emergency ambulance transport to be taken to a kidney dialysis facility.
Eligibility Criteria
For Medicare to cover your ambulance ride, there are several eligibility criteria, including medical necessity, origin, destination, and required documentation.
- Medical necessity: Medicare may cover your ambulance transportation in cases where traveling in another vehicle (such as a car or on public transit) could endanger your health, or you require medically necessary services from a hospital, CAH, a rural emergency hospital, or a skilled nursing facility.
- Origin and destination: Medicare covers ambulance transportation to the nearest healthcare facility that can provide the necessary care. If you choose to transport to a different facility that is farther away — due to personal preference or to be closer to family — Medicare will cover the cost of transport to the closest facility, and you’ll pay the remaining balance out of pocket. Your location also plays a role. For example, if you are in a rural area with no nearby hospitals, Medicare may cover air ambulance transportation when your condition is serious and time-sensitive.
- Required documentation: In some cases, you may be asked to provide documentation, such as NEAT forms from physicians that specify the reason for non-emergency ambulance transportation.
Additional Criteria Based on Ambulance Type
Additional criteria may also apply based on the ambulance type.
- Ground: For Medicare to cover ground ambulance transportation, it must be deemed a severe medical emergency that puts patients at risk if they travel another way. Say you’re cleaning your roof gutters and fall off your ladder, seriously injuring your arm. Your neighbor sees you fall, so he calls an ambulance. Because you could have been transported safely in your neighbor’s vehicle or by taxi, Medicare may not cover the ambulance cost.
- Air: Medicare covers air transport if one of two conditions are met. The first is that ground-based transportation cannot easily reach your location. The second is that obstacles such as traffic could prevent you from getting necessary care. For example, if you are seriously injured in a car accident during rush hour, you may need air transport to ensure you receive care quickly.
- Water: Coverage for water-based transport is similar to air but applies in cases where the quickest and most cost-effective way to reach you is by boat. This could be the case for someone working on an off-shore oil rig or on a ship lost at sea in weather that prevents safe flying.
- Non-emergency: Non-emergency ambulance transportation may be covered by Medicare with proper documentation. This could be proof of conditions such as ESRD or a NEAT form completed by your primary care physician that indicates the reason for traveling by ambulance rather than by car, taxi, or public transportation.
How Often Will Medicare Pay for Ambulance Rides?
While there is no set number of ambulance rides that Medicare will cover throughout the year, there is a Medicare program that applies to patients who receive scheduled, non-emergency ambulance transportation.
If patients receive three or more round trips in a 10-day period, or at least one trip per week for three weeks or more, patients or the ambulance company can request Medicare for prior authorization to ensure the next trip is covered. If the prior authorization is rejected, the cost of additional ambulance services may come entirely out of pocket.
How Does Medicare Advantage Cover Ambulance Transportation?
Medicare Advantage is an alternative to Original Medicare. While it offers the same basic benefits as Original Medicare, it is provided by private insurance companies. Medicare Advantage plans will offer some coverage for ambulance services, but the specifics of that service vary by plan. For example, your Medicare Advantage plan may cover your ambulance ride if the ambulance transports you to an in-network hospital. Medicare Advantage may cover some or none of the cost for healthcare facilities outside the network.
Another option to help cover the cost of ambulance transportation is a Medicare Supplement plan, also called Medigap. These plans can help cover the 20% coinsurance payment you pay for ambulance services under Original Medicare. It’s worth noting, however, that you cannot have both Medicare Advantage and Medigap. Medicare Advantage is a standalone plan, while Medigap is an add-on to Original Medicare.
How Much Would an Ambulance Ride Cost With Medicare?
The costs of ambulance rides have been steadily increasing, rising 22.6% from 2017 to 2020. Moreover, recent research found that 51% of emergency and 39% of non-emergency ambulance rides included out-of-network charges that put patients at risk of surprise bills.
In 2020, the average cost of an ambulance ride was over $1,200.
If you’ve already paid your Part B deductible ($226 in 2023), Medicare ambulance coverage pays for 80% of this ambulance cost, or $960. You pay the remaining $240 out of pocket. In addition, Original Medicare has no out-of-pocket maximum. Even with Medicare coverage, each ambulance ride costs you $240. If you do not have insurance, you pay the entire $1,200 out of pocket.
Other factors may increase the total cost of ambulance transportation, such as the distance traveled or the type of transportation used. For example, if you request transport to a hospital that is not the closest to your current location, Medicare only pays 80% of the cost to get to the closest facility. Other forms of transport, such as air ambulances, may be ten times or more expensive than ground transportation, meaning you could pay $2,400 for each covered ride.
Tips for Managing Ambulance Transportation
There are several options to help keep ambulance costs down.
- Understand your coverage: Make sure you know what your coverage pays for, how much it covers, and under what circumstances.
- Communicate with your healthcare providers: Check with your healthcare providers for any documentation that could help demonstrate that ambulance rides are medically necessary.
- Consider Medigap: Consider Medigap as a way to offset the 20% out-of-post costs of Original Medicare.
- Consider alternative transport: Other options include traveling by car with friends or family or calling a taxi.
What to Do If Medicare Denies Your Ambulance Insurance Claim
You have several avenues of recourse if Medicare denies your insurance claim. Suppose your MSN shows that the reason for denial was that the ambulance company did not fully document your need for transport or did not file the proper paperwork. In that case, you can contact the ambulance company and ask it to refile the claim.
If this is not successful, you may file an appeal. Start by looking at your MSN. It will say why the bill was not covered, how long you have to appeal, and what steps you need to take. Then, ask your doctor for relevant information supporting your appeal case. Finally, send this data to Medicare.
Putting It All Together
Ambulance transportation is expensive. Thankfully, Original Medicare covers up to 80% of the cost of these ambulance rides if they are medically necessary due to an emergency or required to keep patients safe during transport.
While Original Medicare can help offset the total cost of ambulance rides, the lack of an out-of-pocket maximum means that regular ambulance rides could be expensive. As a result, it may be worth considering a Medigap policy to help cover the cost.