Does Medicare Cover Ambulance Services?

Medicare pays 80% of the Medicare-approved amount for ambulance services after you have met your Part B deductible. You will be responsible for 20% 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 2022 is $233. 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.

Coverage for Emergency Ambulance Service

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.

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.

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.

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.

All Medicare Supplement (Medigap) plans cover all or part of emergency and nonemergency Medicare Part B coinsurance. So, your Medigap plan may cover your coinsurance costs for ambulance services.

Actual coverage varies depending on which plan you have. You should read your plan materials or talk to your Medigap plan administrator to find out how much your particular plan will cover.

Only Medigap C and F plans cover part of your Part B deductible. Medigap C and F plans are no longer available if you were not eligible for Medicare before January 1, 2020. If you still have one of these plans, it may cover the cost of your deductible for ambulance services. Check with your plan administrator.

All Medicare Advantage plans cover at least part of your ambulance service costs, but the amount can vary depending on the plan you have and where you live. Different plans may charge you different prices for ambulance services.

If you have a Medicare Advantage plan, it must cover everything Original Medicare covers. But coverage varies from plan to plan.

Some Medicare Advantage plans may cover ambulance services that Original Medicare does not cover. You should check with your Medicare Advantage plan provider to find out exactly what ambulance services your plan covers.

There are several factors that contribute to how much you may have to pay out of pocket for ambulance services if you have Original Medicare.

Ambulance companies are allowed to make a small profit from Medicare payments — about 2% over cost in 2010, the last year the Government Accountability Office looked at costs.

But ground ambulance costs have risen sharply in recent years — up 22.6% between 2017 and 2020, according to a study from FAIR Health. That same study found that people 65 and older — people eligible for Medicare — comprised the largest demographic group using ambulance services. They accounted for 34% of all ambulance service users in 2020.

The study looked at average costs for both advanced life support (ALS) ambulance service and basic life support (BLS) ambulance services. It also broke down average costs for Medicare reimbursement.

This breakdown assumes you’ve already met your Medicare Part B deductible for the year. Your out-of-pocket costs could be higher if you have not met your deductible. These figures also do not consider mileage fees that ambulance services may charge.

These are only estimates of the average costs. Actual costs may vary.

The FAIR Health study also found that Medicare costs for ambulance services only increased about 5% between 2017 and 2020. Non-Medicare ambulance costs rose much more sharply over the same period, leading the study’s authors to suggest that Medicare showed success in somewhat controlling rising ambulance service costs for Medicare beneficiaries.

What If Medicare Does Not Pay for Your Ambulance Service?

You will receive a Medicare Summary Notice (MSN) in the mail every three months when you enroll in Medicare. This lists all services you receive that have been billed to Medicare. It will show you if Medicare denied coverage. You can also check MyMedicare.gov to review your Medicare claim. You may still file a Medicare appeal if you believe Medicare should have covered your ambulance service.

Why Would Medicare Deny Ambulance Service?

There are several reasons why Medicare may deny covering your ambulance service. It may be denied because you were taken to a facility other than an appropriate one closer to you. It may also be denied if you use an ambulance to move from one facility to another or if it’s determined that you could have traveled safely in a car or taxi.

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.

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% 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 your out-of-pocket fees for ground ambulance service in some situations. Medicare does not cover the annual membership fee.