Medicare covers ambulance services, although restrictions apply. Different types of ambulance services are also available to people who need emergency transport.
In this article, we explain which part of Medicare covers ambulance services and the costs that are not covered.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B covers 80% of the costs of ambulance services. The insured person pays the remaining 20% as coinsurance. Medigap plans may cover the coinsurance.
Medicare covers both emergency and nonemergency ambulances, depending on the situation. For example, Medicare covers ambulance services for emergency transport for a person to receive medically necessary services at a hospital.
Emergency transport is usually necessary in a situation when a person’s life is at risk, such as a stroke or heart attack. However, emergency transport is not only vital in life threatening circumstances.
In some cases, transportation to a medical facility by another means, such as a car, would not be safe.
Often, ambulance services involve ground transportation. Other types of emergency medical transport are available, such as airplanes and helicopters.
Depending on which of the following situations apply and which services are medically necessary, Medicare covers 80% of the cost.
Medicare covers ground ambulance transport for people that need taking to a hospital for urgent medical care.
They also pay when transport by other means is unsafe.
Medicare Part B covers the cost of air transport in some but not all cases.
Medicare would pay for an air ambulance if a person needed the service due to a medical emergency when they required rapid transport that was not possible by ground ambulance.
For example, Medicare covers a helicopter in situations where a ground ambulance would take too long, and the delay would endanger a person’s life.
The situation may mean that a ground ambulance cannot reach the individual due to traffic, obstacles, or rough terrain.
The coverage percentage is the same for both air and ground transportation. Medicare Part B covers 80%, and the individual pays a 20% coinsurance.
However, if land transport were available, and using it would not affect the outcome of treatment, Medicare only covers the cost of the ground ambulance.
The insured individual pays the difference if they wish to travel to the hospital by air ambulance regardless.
Medicare also pays for ambulance services in nonemergency situations, such as taking an insured person to a dialysis center for treatment.
For Medicare to confirm cover in nonemergency situations, a person would need to be unable to walk or require medical care during transport.
For instance, a person may need intravenous (IV) fluids or heart monitoring en route, which other means of transportation cannot provide.
Nonemergency ambulance services also require a letter from the doctor stating the ambulance transport is medically necessary.
Some states require written orders before the transport, and others accept it afterward.
If an ambulance company thinks Medicare will not cover a person who needs nonemergency transport, they must provide an Advance Beneficiary Notice of Noncoverage that states what they charge.
While Medicare does cover an air ambulance in some cases, Life Flight coverage involves a different program that is not part of Medicare.
A private membership program provides Life Flight transport in an emergency. Various plans are available.
Enrollees pay a yearly fee and use a Life Flight provider for transport in an emergency. Medicare does not cover the yearly fee.
While it may not be necessary for most people, those that live in remote locations may find it worthwhile to enroll in a Life Flight membership.
Medicare Part A does not cover ambulance services. However, Medicare Advantage Plans, which are an alternative to Traditional Medicare, provide varying levels of cover.
Individual Medicare Advantage Plans vary in coverage. Most plans cover ambulance transport at a higher percentage than original Medicare.
Some Medicare Advantage Plans may have lower coinsurance for ambulance transport than the 20% that applies to Traditional Medicare.
There are some exclusions when Medicare does not cover ambulance services.
For example, Medicare does not cover trips for scheduled appointments, such as for cancer screening or planned surgery. The scheme does not consider a scheduled medical trip to be an emergency.
Medicare will only fund ambulance transport for the procedure if an individual meets the criteria it lists for nonemergency ambulance service coverage.
Usually, Medicare also only covers ambulance transport to the nearest hospital that can provide the necessary care.
A hospital might occasionally be too busy and divert emergencies, requiring an ambulance to use another facility that is further away. Medicare will cover the additional travel costs in these circumstances.
In some cases, an individual may want transportation to a further-away facility because that is their preferred hospital.
Medicare only pays the costs of transport to the nearest hospital that can provide the care. The insured person is responsible for the difference in costs if they wish to travel to a more distant hospital due to preference.
Some ambulance companies offer ambulette transport for people going to doctor’s visits and other medical services.
An ambulette is a wheelchair accessible van that provides nonemergency transport.
Medicare does not cover ambulettes.
Medicare Part B also will not cover ambulance services if someone does not have a ride to a medical appointment, even if it is urgent.
Medicare Part B covers ambulance transport in an emergency.
Transport includes ground ambulances, and in cases where a ground ambulance cannot reach a person, air ambulance transport also.
Medicare also covers nonemergency transports in a few instances. The coinsurance for ambulance services is 20%.