Does Medicare Cover Ambulance Services?
Medicare Part B will cover ambulance costs in an emergency to take you to an appropriate hospital or other medical facility. Medicare will pay for nonemergency ambulance services in certain cases. Air ambulance service is covered if your doctor issues a written order that it is medically necessary.
Medicare and Emergency Ambulance Transportation
Medicare Part B medical insurance covers ambulance services when you’ve had a sudden medical emergency. An emergency is defined as a condition in which your health is in danger and you cannot be safely transported by other means such as a car or taxi.
- Heavy bleeding
- When skilled medical treatment is needed during transport
Medicare will also only pay for an ambulance to take you to the nearest hospital, critical access hospital or skilled nursing facility appropriate for your emergency condition. And Medicare only pays if other types of transportation could endanger your life or health.
How Much Does Medicare Pay for Ambulance Services?
You will be responsible for 20 percent of the Medicare-approved cost of the ambulance trip after you’ve met your yearly Medicare Part B deductible. The Medicare Part B deductible for 2021 is $203.
Medicare pays 80 percent of the Medicare-approved amount for ambulance services after you have met your Part B deductible. The 80/20 share of costs does not kick in until you have met your deductible for the year.
Ambulance companies are required to accept the Medicare-approved amount as payment in full. Generally, Medicare costs for ambulance services are cheaper than other insurance costs.
Ambulance companies are allowed to make a small profit from Medicare payments. That was about 2 percent over cost in 2010, the last year the Government Accountability Office looked at costs.
The average cost for Medicare-covered ambulance trips for all the United States was $429 in that report, but the agency found prices ranging from $224 to $2,204 per ride.
Nonemergency Ambulance Services
Medicare will also pay for ambulance services in limited nonemergency situations, but you must have a written order from your doctor saying the ambulance ride is medically necessary.
To be considered medically necessary, the ambulance trip must be needed to treat or diagnose a medical condition and any other way of getting you there would endanger your health or life.
Medicare may, for instance, cover ambulance services to take you to a dialysis facility if you have end-stage renal disease.
Advanced Beneficiary Notice of Noncoverage
Ambulance companies will consider whether Medicare will cover nonemergency services in your case.
If the company believes Medicare will deny coverage because the trip is not medically necessary or reasonable, it is required by law to give you an Advanced Beneficiary Notice of Noncoverage (ABN). The ABN serves as a notice that the company will charge you for ambulance services.
The ABN allows you to choose to go ahead with the ambulance service and explain your responsibility to pay if Medicare does not. If you choose the option to pay and Medicare denies your claim, you will have to pay the full amount of the ambulance service at the time you receive it.
Prior Authorization for Frequent Ambulance Service
You or your ambulance company may request prior authorization for frequent, nonemergency ambulance trips if you live in certain states. This can help you or the ambulance company determine if Medicare will cover your ambulance services.
The rule applies if you receive scheduled nonemergency ambulance service for three or more round trips in a 10-day period or at least once a week for three weeks or more in eight states and the District of Columbia.
- District of Columbia
- New Jersey
- North Carolina
- South Carolina
- West Virginia
You or the company can send the request to Medicare before your fourth ambulance trip in a 30-day period to see if Medicare will cover the services. If Medicare denies your claim and you continue receiving ambulance services, the company will bill you.
Does Medicare Cover Air Ambulance Services?
Medicare may pay for emergency air ambulance services under certain circumstances. Medicare covers transport by an airplane or helicopter if you require immediate and rapid ambulance service that ground ambulances can’t deliver.
- Your pickup location is not easily accessible by ground transportation.
- Obstacles such as heavy traffic or long distances to a hospital would keep you from getting medical care quickly if you had to rely on a ground ambulance.
People in remote, rural areas may also qualify for Medicare coverage for air ambulance services if their doctor signs an order declaring that the time or distance from an appropriate medical facility was necessary for air transport.
If you qualify, Medicare will cover 80 percent of the Medicare-approved cost of air ambulance services. Some air ambulance programs, such as Life Flight, offer annual memberships that may cover the remaining cost of their services.
The membership may also cover some or all of your out-of-pocket fees for ground ambulance service in some situations. Medicare does not cover the annual membership fee.
Frequently Asked Questions About Medicare Coverage for Ambulance Services
Here are some of the most frequently asked questions about Medicare ambulance coverage.
6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, January). Medicare Coverage of Ambulance Services. Retrieved from https://www.medicare.gov/Pubs/pdf/11021-Medicare-Coverage-of-Ambulance-Services.pdf
- U.S. Centers for Medicare & Medicaid Services. (2019, July). Ambulance Fee Schedule and Medicare Transports. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Ambulance-Transports-Booklet-ICN903194.pdf
- U.S. Government Accountability Office. (2012, October). Ambulance Providers: Costs and Medicare Margins Varied Widely; Transports of Beneficiaries Have Increased. Retrieved from https://www.gao.gov/assets/650/649018.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Ambulance Services. Retrieved from https://www.medicare.gov/coverage/ambulance-services
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How Do I File an Appeal? Retrieved from https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal
- Baily, M. (2017, November 20). Ambulance Trips Can Leave You With Surprising – and Very Expensive – Bills. Retrieved from https://www.washingtonpost.com/national/health-science/ambulance-trips-can-leave-you-with-surprising--and-very-expensive--bills/2017/11/17/6be9280e-c313-11e7-84bc-5e285c7f4512_story.html