Ambulatory coverage is provided by Medicare in certain scenarios. Here are some things you should know:
- You are covered if travel by ambulance is the only safe means of transportation available to you.
- Transportation by ambulance must be to a hospital or skilled nursing facility, from a hospital or skilled nursing facility, or a round trip from a skilled nursing facility or hospital to another skilled nursing facility or hospital.
- Non-emergency transportation is only covered if the ambulance supplier obtains a physician’s certification indicating that the ambulance was a necessary means of transportation because other means were medically contraindicated.
- The transportation must be provided by a Medicare-certified provider.
When Does Medicare Cover Ambulance Service?
Medicare covers ambulance services under specific circumstances, so it’s important to know what you are covered for to avoid large bills. Medicare will pay for ambulance services when the situation warrants it.
Emergency Ambulance Services
Medicare Part B covers ambulance services that are deemed medically necessary and when an alternate means of transportation could be dangerous to one’s health. Medicare will cover ambulance transportation to a hospital or skilled nursing facility, and in some cases will pay for ambulance transportation to and from a dialysis center for patients with end-stage renal disease.
Medicare will only take you to the nearest medical facility that is capable of providing you the care you need. If you request to be taken to an alternate facility via ambulance, Medicare will only cover the costs of the distance between your pickup point and the closest available facility. In extreme circumstances, Medicare will also pay for ambulance transportation via airplane or helicopter if ground travel is deemed a danger to your health.
Non-Emergency Ambulance Services
You may be eligible to be covered for non-emergency ambulance transportation if your health needs to be monitored and travel via a standard vehicle could be hazardous. To qualify, your physician must write an order stating that the ambulance transportation is necessary. You must also be bed-bound (unable to walk or sit) or need medical services during your trip that are only available in an ambulance.
If you receive ambulance transportation for a non-emergency, the ambulance company must provide you with an Advance Beneficiary Notice of Noncoverage if it believes that Medicare may not pay for your transportation.
Ambulance Cost With Medicare
The cost of an ambulance is 20% of the Medicare-approved trip amount after you have met the yearly Part B deductible. This percentage may change if you are taken to a critical access hospital as opposed to a regular hospital or skilled nursing facility. Ground ambulance costs can vary between $200 and $2,000. Medicare may determine after the fact that the trip did not constitute an emergency and will bill you directly.
Which Parts of Medicare Cover Ambulance Service?
Original Medicare beneficiaries will have ambulance services covered through Medicare Part B. Medical treatment during the transport is typically paid for under Medicare Part B, but not always. If you have Medicare Advantage, the cost of ambulance services and medical care during transport is covered through Medicare Part C.
You must have Medicare parts A and B to be eligible for a Medigap policy, which may cover all or part of the costs of ambulance services that Medicare does not cover.
Does Medicare Pay for an Air Ambulance?
If an air ambulance is required for emergency medical treatment because you cannot be properly transported via ground, Medicare may cover up to 80% of the Medicare-approved costs of air ambulance services, which can be in a helicopter or airplane.
There are also private membership programs available, such as Life Flight, which require an annual membership fee not covered by Medicare. This may cover the portion of the cost that’s not paid for through Medicare. Some of these programs also cover ground ambulatory transportation not covered by Medicare.
Does Medicare Cover Transportation to Regular Appointments?
Medicare does not cover transportation to standard doctor’s appointments, but may cover ambulance trips if your doctor writes an order stating that the ambulance transportation is necessary for a medical condition, such as to radiation or dialysis appointments. Some states allow patients to schedule non-emergency ambulance transportation, so you can figure out if these trips will be covered ahead of time.
What if Medicare Ambulance Coverage Is Denied?
If you are refused coverage, you may not have to pay the full cost still. You can review your Medicare Summary Notice which covers the period during which you took an ambulance ride. The MSN is a summary of all health services you received that were billed to Medicare and should give you an explanation as to why your trip was not covered. If there was no error and Medicare won’t pay for your ambulance ride, you can appeal that decision if you feel your trip should have been covered.
The steps to appeal are:
- 1. Review your Medicare Summary Notice to see why the claim was denied.
- 2. Call the hospital, health center, or doctor who cared for you and ask for complete information so you can resubmit the claim.
- 3. Talk to the ambulance service to see if they need to fix any errors and resubmit their paperwork.
- 4. Consider filing an appeal.
Medicare Ambulance Services FAQs
Does Medicare pay ambulance fees?
Medicare Part B pays 80% of your ambulance transportation fees after the yearly deductible has been met. Emergency ambulance trips are covered only when taking any other vehicle would endanger the patient’s health, and non-emergency visits are only covered if the patient has a written order from their doctor stating that the ambulance transportation is necessary.
Will Medicare pay for ambulances from hospital to home?
Medicare usually does not pay for the ambulance trip back home unless it is for an emergency or if a written doctor’s order deems it medically necessary.
Does Medicaid pay for ambulances?
Medicaid pays for emergency ambulance transportation if the providers are licensed by the state, and it covers non-emergency ambulance transportation if you have a written doctor’s order. Coverage varies by state so always check with your provider to gain a full understanding.
Will Medicare pay for medical transportation?
Medicare Part B covers medical transportation with a written doctor’s order or in an emergency – however, coverage is never fully guaranteed.
How are ambulance services billed?
These services are billed after the trip, and you will receive a notice regarding whether Medicare covered the tip in your online Medicare account or your next Medicare Summary Notice.