Medicare covers emergency transport by ground or air, as long as it is deemed medically necessary and meets specific requirements.
Medicare Part B covers the emergency ground or air ambulance services that a person may need.
In specific circumstances, nonemergency transportation may also be covered.
This article will look at how Medicare covers emergency transportation costs and under what circumstances the plan will generally approve coverage.
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 emergency and nonemergency ambulance services when they are deemed medically necessary.
Medicare covers 80% of eligible transport costs. A person may then be responsible for the remaining 20% as coinsurance.
The coinsurance will usually apply after a person has paid the Part B deductible in full.
Ambulance coverage is normally available to and from the following places:
|a person’s home||a hospital or skilled nursing facility (SNF)|
|the nearest healthcare provider||an SNF|
|the nearest appropriate renal dialysis facility||a person’s home (round trip included)|
Medicare Part B will normally cover ambulance services when:
- there is a sudden medical crisis
- there is a severe risk to a person’s health
- moving a person from one location to another may be impossible without the help of the emergency services
- a person is losing a lot of blood, is unconscious, or in shock
- an individual is to receive a Medicare-covered service
- a person is going to and from locations within the Medicare coverage guidelines
- the ambulance service meets Medicare requirements
- it is medically necessary
If an ambulance trip is prearranged, and a person’s health is not in immediate danger, Medicare may not consider this an emergency.
Medicare covers nonemergency ambulance services when a person is:
- unable to stand without assistance
- not able to walk
- unable to sit in a wheelchair or chair
- in need of vital medical services during a trip (this may include the monitoring of vital functions)
Skilled nursing facilities and transport
If a person lives in a skilled nursing facility, Medicare may cover nonemergency trips.
A doctor must provide a letter to advise that travel is necessary, and, when a person has Medicare Part A, the SNF should pay for transport costs.
The facility should not charge Medicare for transport services.
Medicare does not cover ambulette services.
An ambulette is a van that can accommodate a wheelchair and provides nonemergency transport.
Helicopters and airplanes are sometimes used when a person needs immediate and rapid transportation that a ground ambulance cannot provide.
If a person is medically required to travel to the hospital by air, in either an airplane or helicopter, Medicare may pay for these services, provided ground transport is unable to reach a location, or heavy traffic or long distances will stop urgent care.
Medicare has programs that can help with transport costs, providing a person meets specific eligibility criteria.
Medicaid is available for some individuals who have limited resources.
Medicaid may help pay for Medicare costs, such as copayments and deductibles, and may also pay for services that Medicare does not cover.
Additional benefits may include dental care and transport to medical appointments.
Medicare Savings Programs
Medicare Savings Programs (MSPs) can also help with costs.
There are four different types of MSP, each offering different benefits:
- Qualified Medicare Beneficiary (QMB) programs: These plans help pay premiums for parts A and B. They also help to pay copayments, coinsurance, and deductibles.
- Specified Low-Income Medicare Beneficiary (SLMB) programs: These programs help pay the premium for Part B only.
- Qualifying Individual (QI) programs: These plans also help cover the premium for Part B only.
- Qualified Disabled and Working Individuals (QDWI) programs: These plans help pay the premiums for Part A only.
Medicare Part B may cover emergency transport by road or air ambulance if it is deemed necessary and under certain conditions.
Medicare may also consider coverage for nonemergency transport if a person is immobile or requires specific medication.
In most cases, a person may need a letter from a doctor stating that the ambulance or air transport is medically necessary.
Additional financial support may be available to those with limited resources.