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Does Medicare cover ambulance services?


Yes, but not every ambulance ride.

In an emergency, the last thing you want to worry about is whether Medicare will cover your ambulance or emergency medical transport (EMT) service. But it’s good to know before you call 911 that Medicare covers ambulance services in limited circumstances.

Emergencies. When you’ve had a sudden medical emergency and your health is in serious danger.

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In this case, Medicare will cover the transport if you require medically necessary services at a hospital or skilled nursing facility but can’t be safely moved otherwise. This may include emergency medical situations when you’re in shock or unconscious, bleeding heavily or need skilled medical treatment while in transit.

Some nonemergencies. Medicare may cover ambulance transportation in some cases when you’re not facing a medical emergency.

To receive this coverage, your doctor needs to write an order stating that an ambulance is medically necessary because other ways to get you to an appointment could endanger your health. For example, if you’ve been diagnosed with end-stage renal disease, Medicare may approve an ambulance to and from a dialysis center, but only if having a friend drive you, calling a cab or sending for Lyft or Uber could jeopardize your health further.

Today, all 50 states and several territories require prior authorization for regularly scheduled, nonemergency ambulance services.

Air transport. Medicare may pay for an emergency flight in an airplane or helicopter if the trip would take too long on the ground and endanger your health.

Medicare will cover ground or air transit to what it considers the nearest appropriate medical center. If you choose to go farther away, Medicare will pay to get you to the closest place that can give you the care you need; you’ll have to pay the rest.

How much do I pay for covered ambulance services?

Medicare Part B covers qualified ambulance services after you pay the annual Part B deductible, which is $233 in 2022 and $226 in 2023. You’ll also be responsible for a 20 percent copay of the Medicare-approved amount.

If you have a private Medicare supplement policy, also known as Medigap, you’ll have coverage for the 20 percent Part B coinsurance.

Medicaid and Medicare Advantage plans may provide nonemergency transportation benefits beyond what Medicare covers. For example, some Medicare Advantage plans pay for round trips to a specified number of scheduled doctor appointments.

Keep in mind

If you want to use an ambulance when you’re not facing an emergency and ambulance service officials believe that Medicare won’t cover the transportation, they may be required to give you an advance beneficiary notice of noncoverage (ABN). This form states that you may be responsible for the entire bill.

If you receive a noncoverage notice, you need to check a box on the form for one of three options.

  • You want the service and want the provider to submit a claim to Medicare. If Medicare denies the claim, you have a right to appeal. You’ll receive information about the denial and instructions for filing an appeal in your Medicare Summary Notice.
  • You want the service but don’t want the claim sent to Medicare.
  • You choose to forego the service.
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But ABNs for ambulance services can get complicated. The ambulance company must give you a notice if Medicare usually covers the service but expects that Medicare won’t pay because the method isn’t medically necessary.

This could occur if you want a helicopter flight when a ground ambulance could safely take you. However, ambulance companies can’t require you to sign an ABN for what Medicare considers emergency services.

There’s more. The ambulance company is not required to give you an ABN if you request a service that Medicare doesn’t cover, such as calling an ambulance when you’re not in an emergency situation and don’t have a doctor’s order allowing the transit.

If you hurt your ankle and want an ambulance to take you to the hospital, your health won’t be in danger if you go to the emergency room in a car. The ambulance company may voluntarily give you an ABN to let you know the service likely won’t be covered, but Medicare doesn’t require it.

Published November 23, 2022

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