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.
- Written by Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
- Edited ByMatt Mauney
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.Read More
- Reviewed ByAflak Chowdhury
Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.Read More
- Published: June 26, 2020
- Updated: January 10, 2023
- 8 min read time
- This page features 6 Cited Research Articles
- Edited By
|Medicare Plan||Coverage for Ambulance Services|
|Part A (Inpatient)||N/A|
|Part B (Outpatient)||Covers 80% of qualifying ambulance costs after you have reached your Part B deductible.|
|Part C (Medicare Advantage)||Coverage mirrors Part B. Select plans may offer additional benefits.|
|Part D (Prescription Drugs)||N/A|
|Supplemental Insurance||Can help cover out-of-pocket ambulance costs. Coverage varies by plan.|
How Much Does Medicare Pay for 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.
- 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.
Medicare and 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 Medigap Cover Ambulance Services?
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.
Does Medicare Advantage Cover Ambulance Services?
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.
How Much Does the Average Ambulance Ride Cost Out-of-Pocket?
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.
|TYPE OF PAYMENT||BASIC LIFE SUPPORT||ADVANCED LIFE SUPPORT|
|Medicare||$390.00 (80%)||$463.00 (80%)|
|Potential Maximum Coinsurance Out-of-Pocket Cost||$97.50 (20%)||$115.75 (20%)|
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.
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% 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.
6 Cited Research Articles
- FAIR Health. (2022, February 23). Ground Ambulance Services in the United States. Retrieved from https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Ground%20Ambulance%20Services%20in%20the%20United%20States%20-%20A%20FAIR%20Health%20White%20Paper.pdf
- U.S. Centers for Medicare & Medicaid Services. (2022, January). Medicare Coverage of Ambulance Services. Retrieved from https://www.medicare.gov/Pubs/pdf/11021-Medicare-Coverage-of-Ambulance-Services.pdf
- 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
- 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/gao-13-6.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
Calling this number connects you to one of our trusted partners.
If you're interested in help navigating your options, a representative will provide you with a free, no-obligation consultation.
Our partners are committed to excellent customer service. They can match you with a qualified professional for your unique objectives.
We/Our Partners do not offer every plan available in your area. Any information provided is limited to those plans offered in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.888-694-0290