Medicare covers ambulance services, although restrictions apply. People who need emergency transport can get different types of ambulance services, such as road or air, depending on the situation.
Medicare may cover emergency or nonemergency ambulance transportation, depending on the situation.
In this article, we explain which part of Medicare covers different types of ambulance services and list the costs that Medicare does not cover.
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.
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.
Medicare may also cover nonemergency ambulance rides.
Cases in which Medicare may cover ambulance services include:
- Emergency ground ambulance: Under original Medicare, a person can get an emergency ground ambulance service if transportation in any other vehicle would endanger the person’s health.
- Emergency air ambulance: 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, if the person’s condition is deteriorating fast or their location is remote, an air ambulance may be necessary.
- Nonemergency ambulance: Medicare may pay for nonemergency ambulance transportation if the person provides a letter from a doctor stating that 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.
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 a nonemergency.
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 transport in an emergency. A person can choose from various plans.
Enrollees pay a yearly fee and use a Life Flight provider for transport in an emergency. Medicare does not cover the membership fee. In an emergency, Medicare may pay for the 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.
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.