Key takeaways
- Medicare Part B covers ambulance services when transport in another vehicle could endanger a person’s health. Services include emergency ground and, in some cases, air ambulance transport.
- Medicare Advantage (Part C) plans also cover ambulance services, but they may have different cost structures and potentially restrict the ambulance companies a person can use for nonemergency transport.
- Medicare may deny ambulance bill coverage due to paperwork errors, such as incomplete documentation from the ambulance company. In such cases, a person can request a corrected form or submit additional documentation, and they have the right to file an appeal if necessary.
Medicare Part B covers ambulance travel in situations where traveling to a hospital in any other vehicle would endanger a person’s health. This will typically cover ground ambulance travel, but in certain circumstances, air transport may also be eligible.
In this article, we explain which part of Medicare covers different types of ambulance services and list the costs that Medicare does not cover.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Under original Medicare, Medicare Part B covers 80% of the costs of an emergency ambulance service. The insured person pays the remaining 20% as coinsurance. Medigap plans may cover the coinsurance.
Cases in which Medicare may cover ambulance services include:
Emergency ambulances
Under the original Medicare, a person can get an emergency ground ambulance service if transportation in any other vehicle endangers the person’s health.
Medicare may pay for emergency ambulance transportation by air if ground transportation will prevent a person from getting the medical treatment they need quickly enough. For example, an air ambulance may be necessary if the person’s condition is deteriorating fast or their location is remote.
Nonemergnecy ambulances
Medicare may pay for nonemergency ambulance transportation if the person provides a doctor’s letter stating that the transportation is medically necessary.
One example is when a person needs to have dialysis treatment during transportation. If an ambulance company thinks that Medicare will not cover a person who needs nonemergency transport, it must provide an Advance Beneficiary Notice of Noncoverage that states what it charges.
What ambulance services does Medicare not cover?
Medicare will not pay for ambulance trips for scheduled medical appointments that a doctor does not certify as requiring ambulance transportation.
Medicare also will not pay for urgent or scheduled medical appointments if an enrollee does not have a ride to that appointment.
Medicare requires that Medicare Advantage plans cover at least the same services as original Medicare. Therefore, Medicare Advantage policies will usually cover ambulance services. However, they may restrict the ambulance companies that a person can use for nonemergency situations.
The cost structure may also vary. A person should carefully read their Medicare Advantage plan benefits to ensure that they understand the potential costs of ambulance transportation under their plan.
Life Flight is a private membership program that provides emergency transport. Members can choose from various plans.
Enrollees pay a yearly fee and use a Life Flight provider for transport in an emergency. Medicare does not pay for the Life Flight membership fee.
However, in an emergency, Medicare may pay for the Life Flight transportation itself unless it deems that other viable transportation was available, but the person did not use it. In such cases, Medicare may deny the claim.
Although Life Flight may not be necessary for most people, those who live in remote locations may find it worthwhile to enroll in a membership. A basic Life Flight membership for an air ambulance costs $85 per month.
If Medicare denies covering a person’s ambulance bill, they will typically find out via the Medicare Summary Notice (MSN), which arrives in the mail every three months and outlines all the services billed to Medicare. A person can also check their coverage online on their account with Medicare.gov.
One common reason Medicare could deny coverage for an ambulance ride involves paperwork errors. For instance, this can happen if the ambulance company did not properly document the reason the person needed the ride, or it filed the wrong form.
In these cases, a person can request that the company file the correct form or contact their doctor for additional documentation about their ambulance trip that they can submit to the ambulance company and to Medicare as needed.
If these solutions do not result in coverage, a person can file an appeal.
Medicare Part B covers ambulance transportation in an emergency. The transport options include ground ambulances and, in cases where a ground ambulance cannot get a person to a hospital in time, air ambulance transport.
Medicare also covers nonemergency transportation in a few instances. The coinsurance for ambulance services is 20% in original Medicare, while for Medicare Advantage, the cost structure may vary depending on an individual’s plan.