Does Medicare cover ambulance services?

Medicare will pay for ambulance services under specific circumstances, but it's important to know what these are to avoid hefty bills.

Q. Does Medicare cover ambulance services?

A. Medicare will pay for ambulance services under specific circumstances, and it’s important to know what these are to avoid hefty bills.

2020 Medicare premiums, deductibles, costsWhen emergencies arise, or when preexisting medical conditions make traditional transportation unsafe, the safest way to get to a hospital or care facility is often via ambulance.

The good news is that Medicare will pay for ambulance services when the situation warrants it.

Emergency ambulance service

Medicare Part B will cover ambulance services when it’s deemed medically necessary, and when an alternate means of transportation could be hazardous to your health. For example, if you’re in shock, unresponsive, or bleeding heavily, Medicare will generally pay to transport you by ambulance. But if you’re dealing with an injured arm or leg that may be broken, that’s not reason enough to warrant an ambulance.

The reason for your ambulance trip must be to receive a Medicare-covered service, or to return after having received care. Medicare will cover ambulance transportation to a hospital or skilled nursing facility. In some cases, it will also pay for ambulance transportation to and from a dialysis center for patients with end-stage renal disease.

Medicare will only pay for an ambulance to take you to the nearest medical facility that’s able to provide the care you need. If you request an alternate facility that’s farther away, Medicare will only cover the cost of the distance between your pickup point and the closest facility available.

In extreme cases, Medicare will also pay for ambulance transportation in an airplane or helicopter if ground travel is deemed a danger to your health – such as, if your pickup location can’t be reached easily by ground transportation, or if obstacles like distance or traffic are likely to put your health in danger by delaying your arrival at a care facility.

Non-emergency ambulance service

You may be eligible for covered non-emergency ambulance transportation if your health requires monitoring, and travel via a standard vehicle could be hazardous given your condition. To qualify for non-emergency ambulance service, your physician must write an order stating that ambulance transportation is necessary. You must also be confined to a bed (meaning, unable to walk or sit in a wheelchair) or need medical services during your trip that are only available in an ambulance setting, such as monitoring or IV medication.

When you receive ambulance transportation for a non-emergency situation, the ambulance company providing that ride must provide you with an Advance Beneficiary Notice of Noncoverage (ABN) if it believes that Medicare may not pay for your transportation. At that point, you’ll have the option to decide whether you want to be transported by ambulance or not, and you’ll be forced to acknowledge that you’re responsible for covering that cost if Medicare doesn’t end up paying. You may also be required to pay for your ambulance service up front.

Your costs for ambulance services

Regardless of whether your ambulance trip is considered emergency or non-emergency, you’re responsible for a portion of its cost. Medicare will cover 80 percent of its approved amount of that service, and you’ll be responsible for a 20-percent coinsurance once your Part B deductible for the year is met.

What if Medicare doesn’t pay for your ambulance?

If Medicare refuses to cover your ambulance service initially, you’re not necessarily on the hook for its entire cost. If your ambulance claim is rejected, review your Medicare Summary Notice (MSN) that covers the period during which you took an ambulance ride.

Your MSN is a summary of all of the health and health-related services you received that were billed to Medicare during the preceding three-month period, and it should give an explanation as to why your ambulance trip wasn’t covered.

Review your MSN for errors that could’ve resulted in Medicare’s refusal to pay. For example, if the ambulance company you used didn’t properly document why you needed its transportation, or if it filed the wrong paperwork, you could end up denied, in which case having your claim resubmitted could resolve the issue.

If there was no error at play and Medicare won’t pay for your ambulance ride, you have the right to appeal that decision if you feel your trip should’ve been covered. Your MSN should provide instructions on how to begin the appeals process.

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Ed HILL

Will Medicaid or Medicare pay for transportation from Jacksonville to miami moving my mom who is bedden home

Maurie Backman

Usually there has to be a medical need for ambulance service for it to be covered. If your mother is moving from one home to another, that’s generally not considered an emergency. If she’s moving from a medical facility in Jacksonville to another medical facility in Miami, that service may be covered.

Barbara

If you needed medically necessary ambulance transfer and the hospital was chosen by the doctors where the best facility was that could manage your care, are you responsible for the uncovered miles

Maurie Backman

Medicare will generally only cover ambulance services to the nearest appropriate medical facility that can provide the care you need. If your doctor feels that a facility farther away was most appropriate, Medicare may pick up the tab. If that doesn’t happen, you can file an appeal with a letter of necessity from your doctor.

Frankie delise

My husband is 100% disabled vet but he only has Medicare part a he gets all his medical needs free at the VA hospital But during our worst hurricane he fell and broke his hip and the VA hospital was on lockdown and refused to let me bring him there so I had to call an ambulance and now the VA according to the ambulance service is refusing to pay for it will his Medicare part a cover it

Maurie Backman

Ambulance service is covered under Medicare Part B. If you don’t have Part B, you may have to pay that cost yourself, unfortunately.

Bill Speck

Will Medicare pay for an ambulance called and then patient not taken to the hospital?

William

If you go to a hospital ER by car and they say they can’t treat you and must transfer you to another hospital and do so through an ambulance service is there the 20% or health insurance copay due It was not an emergency but I was told I needed to get to the other hospital by ambulance to get treated I was admitted for 3 days for cardiac and Blood Pressure IT seems it would be the same as transferring someone from hospital to rehab home. And I have had 3 trips from hospital to rahab in the past… Read more »

Cheryl Chandler

My dad was called by his dr’s office same day as his bloodwork to go immediately to the hospital for extremely low hemoglobin levels. His only option was an ambulance. How do we get this covered my Medicare?

Margaret

My husband passed out & stopped breathing while at restaurant having dinner. 911 was called & ambulance took him to hospital. It was matter of life or death. Can’t believe we have to pay for part of ambulance. BC/BS said it was because it was a “facility ambulance”. Three years ago while in Florida he had a stroke. I took him to Emergency Room. They, in turn, took him to hospital via ambulance & we did not have to pay anything for ambulance. I don’t understand this at all. We lost our supplementary insurance due to pandemic & now we… Read more »