Medicare

Does Medicare Cover Ambulance Transportation?

No one wants to wait until an emergency to wonder if their insurance covers the care they need. While Medicare Part B covers medically necessary ambulance rides,  it also restricts and limits some coverage. Paying Part B premiums and understanding your deductible are critical to ensuring Medicare ambulance coverage.

Medicare Amblance Service

For someone experiencing a medical emergency, wondering if Medicare will cover their ambulance transportation can cause additional stress. Medicare ambulance coverage allows beneficiaries to trust that their benefits have them covered, and focus on getting the immediate help they need.

Does Medicare Cover Ambulance Transportation?

Medicare covers ambulance transportation in most emergencies. Specifically, Medicare Part B includes ambulance transportation under medically necessary healthcare. Medicare deems an ambulance ride as a medical necessity when transporting the beneficiary in any other vehicle during an emergency could endanger their health.

Medicare may cover a variety of emergency and non-emergency ambulance rides, whether on the ground or in the air. The type of benefits one receives helps determine their individual Medicare ambulance coverage and costs. Beneficiaries should understand their Medicare coverage before they find themselves in an unexpected medical emergency.

Coverage for Emergency Ambulance Service

Medicare may cover transportation, including emergency and non-emergency, ground ambulance, or air ambulance services, when medically necessary. Medicare covers transportation for beneficiaries experiencing a life-threatening or immobilizing injury or illness. Coverage includes transportation to the closest skilled nursing facility or hospital for Medicare-covered treatment. 

Non-Emergency Ambulance Rides

Medicare will cover a non-emergency ambulance ride under specific conditions. Requirements for Medicare to cover this service include an order from your physician validating the need for non-emergency ambulance transportation, such as for end-stage renal disease treatment. 

You must also be confined to a bed or require treatment, such as an IV, that can only be provided in transit by ambulance. If an ambulance company believes Medicare may not cover your trip, they must provide you with an advance beneficiary notice of non-coverage form. You can then decide whether or not to take the ambulance, which may require up-front and out-of-pocket costs.

Ground Ambulance Rides

Ground ambulance vehicles transport patients via roadway to the nearest skilled nursing facility, medical facility, or clinical access hospital. Medicare covers the cost of ground transportation in an ambulance for beneficiaries that cannot safely travel to a medical facility in a civilian vehicle. 

Medicare Part B will cover ground ambulance rides for beneficiaries experiencing a medical emergency, such as severe shock or internal hemorrhaging, or those in need of continuous monitoring or treatment for the duration of the trip to the facility. Provided these conditions are met, and a safe route exists, Medicare will cover ground ambulance rides as the first course of action.    

Air Ambulance Flights

Medicare may cover your trip to a skilled nursing facility, clinical access hospital, or other medical facilities by airplane or helicopter. Note that Medicare only covers air ambulance flights if the patient cannot be accessed via a ground ambulance or if doing so creates an unsafe or unhealthy environment for the beneficiary and/or EMT crew.

Medicare also covers air ambulance flights if the distance to the nearest medical facility or another obstacle, such as traffic, would inhibit ground transportation. 

How Much Does Medicare Pay for Ambulance Services?

For Part B beneficiaries who have met their annual deductible, Medicare ambulance coverage accounts for the majority of the coinsurance costs for this service. You are responsible for paying the smaller portion of the coinsurance costs if you have met your deductible, or coinsurance plus the remainder of your deductible, to get Medicare ambulance coverage.   

What Does Medicare Supplement Insurance Cover?

Since you must enroll in Medicare parts A and B to qualify for Medicare Supplement insurance–also known as Medigap–you still have Part B ambulance coverage with supplemental benefits. Medigap benefits and costs vary by provider and location.

Medigap is offered privately as a supplement to original Medicare and can help recipients fill in the gaps in their coinsurance and deductible costs. Beneficiaries must stay current on Part B premium payments to continue to receive Medigap benefits. Medigap may also cover emergency ambulance care while traveling outside the United States.

Does Medicare Advantage Cover Ambulance Services?

Medicare Advantage is offered privately through third-party insurance providers, intended as an extension of original Medicare benefits. Advantage plans provide the same benefits as Part A and Part B, including Medicare ambulance coverage, but with additional benefits like dental and vision.

Since providers can set their own cost for Medicare Advantage by location and availability, the premium rates vary per beneficiary. Recipients must pay both their Part B and additional Advantage premiums each month to continue to receive coverage. Since it is an extension of Part B benefits, Advantage enrollment is not required to receive Medicare ambulance coverage.

Ambulance Coverage Under Medicare Part B

Medicare ambulance coverage is included under Part B benefits as a medical necessity. The Centers for Medicare and Medicaid Services project a standard deductible of $223 and a monthly premium of $165 for Part B beneficiaries in 2023. 

Medicare covers 80% of approved emergency or non-emergency ambulance costs after a beneficiary meets their Part B deductible. Medicare recipients who have not yet met this deductible are responsible for paying the remainder of the deductible plus 20% coinsurance. 

How Much Does the Average Ambulance Ride Cost Out-of-Pocket?

Generally, paying for an ambulance ride without insurance is quite costly; however, the actual cost depends on multiple variables. Factors affecting the out-of-pocket costs of an ambulance ride include a person’s location, miles traveled to a critical access hospital or medical facility, whether the ride is emergency or non-emergency, and the level of care provided on the trip.

Some cities provide free emergency services such as ambulance rides as taxpayer benefits. Others offer membership programs for citizens who anticipate the need for ambulance rides not covered by insurance. The average out-of-pocket cost for an ambulance ride varies based on state, but many can exceed a base cost of $1,500, not including the amount charged per mile.

Medicare and Nonemergency Ambulance Services

You may qualify for limited non-emergency Medicare ambulance coverage, provided you meet the requirements. Medicare covers non-emergency ambulance rides only when the beneficiary submits an order from their physician specifying this mode of transport as a medical necessity. 

This includes patients who are bedridden or require constant, uninterrupted monitoring or treatment during their ambulance trip. For example, patients suffering from an end-stage renal disease commonly need a non-emergency ambulance to get to dialysis treatments. Medicare currently considers the approval of single trips on a case-by-case basis.   

What If Medicare Does Not Pay for Your Ambulance Service?

Beneficiaries who are retroactively denied Medicare ambulance coverage have multiple options.  The first step requires accessing your Medicare summary notice to check the itemized details of your claim. In some cases, a human or clerical error regarding the treatment you received in the ambulance or documentation of your doctor’s order can lead to the rejection of your claim. 

If you find an error, you can resubmit your claim with the corrected information. However, if no unexpected errors exist and you feel Medicare should have covered your ambulance trip, you can file an appeal. Start by checking the appeal deadline listed on your Medicare summary notice, then you can complete and submit a redetermination request form to Medicare Appeals.