It’s not uncommon to see the flashing lights and hear the blaring siren of an ambulance rushing to someone’s aid or transporting them to the hospital for emergency treatment. And no matter whether the ambulance is operated by a private company or a government entity, they are an important element among first responders.
Hopefully, you’ll never have to use an ambulance service. But if you do, there’s a cost. And for people on Medicare, the question is, who pays for the ambulance ride and how much. The answer varies, depending on whether you have Original Medicare (Parts A & B), a Medicare Advantage plan, or a Medicare Supplement policy.
If you have Original Medicare, Part B covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health.
If you call an ambulance in an emergency, follow up with the ambulance service to make sure they document the transport as an emergency because of what you knew and what you were experiencing when you called. In other words, it was medically necessary.
In some cases, Medicare may pay for emergency ambulance transportation in an airplane or helicopter to a hospital if you need immediate and rapid ambulance transportation that ground transportation can’t provide.
Non-emergency transportation is an entirely different issue. In some cases, Medicare may pay for limited, medically necessary, non-emergency ambulance transportation. You have to have a written order from your doctor stating that ambulance transportation is medically necessary. An example might be someone with End-Stage Renal Disease who needs ambulance transport to a facility that furnishes renal dialysis. In general, the patient must be confined to bed or need necessary medical services during the trip.
In a non-emergency situation, if the ambulance company thinks Medicare may not pay your specific ambulance claim they have to give you an “Advance Beneficiary Notice of Noncoverage.
So, under Original Medicare, who pays what for medically necessary ambulance rides?
- You pay 20% of the Medicare-approved amount
- You pay the Medicare Part B deductible if you haven’t already met it. In 2021 the deductible is $203
- Medicare Part B pays 80% of the Medicare-approved amount
Keep in mind that Medicare will only cover ambulance services to the nearest appropriate medical facility that’s able to give you the care you need. If you request being taken to some other facility, then you may have to pay more.
If your coverage comes from a Medicare Advantage plan, that plan must provide, at a minimum, the same coverage as Original Medicare Part B. In many MA plans, ambulance coverage goes beyond the bare minimum required and often may only require you to pay a flat rate as your part of the ambulance bill.
Medicare supplement insurance, or Medigap, may help cover the cost of ambulance transportation. Medicare supplements generally cover at least part of your Medicare Part B copayments and coinsurance.
There are occasions when Medicare ambulance claims are denied. If that happens file an appeal. Have all your information ready to prove that it was medically necessary and that the ambulance service correctly coded the transportation as an emergency.
