You never know when you may need an ambulance due to a serious illness or injury. Understanding what is and isn't covered, and when, can help make sure you get the emergency transportation services you need without having to pay the cost completely out-of-pocket.

Does Medicare cover ambulance services?

If you've had a sudden emergency and other means of transportation could endanger your health, ambulance services may be covered to take you to or from the nearest hospital or facility.

However, there are specific guidelines around what is and isn't covered.

For example,

• Services are only covered when other transportation, such as a car, will endanger or risk your health or life. If Medicare determines you could have been moved safely by other means, they may not cover the service.
• The ambulance must take you to the nearest appropriate medical facility. If you want to be taken somewhere else, or farther away, Medicare will only pay the cost to take you to the closet facility. You'd then have to pay the rest of the cost out-of-pocket.
• Medicare may cover emergency air transportation in an airplane or helicopter if you need immediate and fast transport that can't be provided by a ground ambulance.
• Nonemergent ambulance transport may be covered if you have a written order from your doctor stating it's medically necessary.

When Medicare covers emergency ambulance transportation

If you need to be taken to a hospital or medical facility quickly, and other means of getting there could risk your health or life, emergency ambulance transportation may be covered.

Examples include if you're unconscious, bleeding heavily, having a heart attack or stroke, or have another life-threatening illness or injury.

Medicare will evaluate the seriousness of your medical condition, as well as whether you could have been safely transported by other means, before determining if the service is covered.

When Medicare will pay for air ambulance services

Air ambulance services are covered if a ground ambulance can't provide the immediate and urgent transport you need due to your illness or injury. Also, to be covered,

• Your location cannot be easily reached by ground ambulance, or
• Long distances or other obstacles (like traffic) could prevent you from getting the care you need quickly

If you live in a rural area, you automatically meet these requirements if a doctor states air transport is necessary, and it meets the air ambulance requirements from Medicare.

If your current hospital lacks the equipment or surgical staff to perform the emergency surgery or procedure you need, Medicare may approve air ambulance to take you to a place better equipped. However, there must be the chance of severe risk to your health, or the possibility of death, before this would be covered.

Typically, Medicare prefers ground over air ambulance due to the service cost.

Medicare coverage for non-emergency ambulance transportation

You may be able to get non-emergency ambulance transportation as long it's needed to treat or diagnose a health condition and using other transportation means could endanger your health.

The transport must be deemed medically necessary by your doctor, who must write an order stating it's necessary due to your medical condition. In some cases, you must also:

• Be unable to walk or sit in a wheelchair, or
• Need medical services during your trip that can only be provided in an ambulance setting, such as monitoring or administering medication through an IV

An example of when you may need non-emergent services is if you have end-stage renal disease (ESRD) and need transport to a facility for renal dialysis.

In some states, prior authorization is necessary if you use non-emergency ambulance transportation for three or more round trips within a 10-day period, or at least once per week for three or more weeks. If you are using ambulance transportation for non-emergent situations, talk with your doctor or contact Medicare to understand any limitations that apply.

Do Medicare Advantage plans cover ambulance transportation?

Medicare Advantage (Part C) plans must provide the same coverage as Original Medicare Parts A and B, so they also cover ground and air ambulance transportation when it's deemed medically necessary. The difference in coverage is primarily the cost.

Part C plans may also offer more coverage for non-emergency medical transports. For more information about your specific coverage, contact your plan.

What is the "Advance Beneficiary Notice of Noncoverage"?

When providing non-emergent ambulance services, the ambulance company must consider whether Medicare will cover the transport. If the company believes Medicare won't pay for the service because it's not deemed medically necessary, they must give you an Advance Beneficiary Notice of Noncoverage, or ABN.

An ABN is a notice that the ambulance company is providing a service they believe Medicare may not cover and gives them the ability to charge you for the service.

On the ABN, you'd check a box to choose if you still want the service, and explain you accept and will be responsible for the payment if Medicare doesn't cover it.

In some cases, the company may require you pay at the time of service. Or they may send you a bill for the costs.

If you refuse to sign the ABN, the ambulance company can decide if they still want to transport you by ambulance. If they decide to still take you, you could still be responsible for paying for the trip.

Will the ambulance company always give you an ABN?

If you're receiving emergency transportation, you won't be required to sign an ABN.

There are also non-emergent or other situations when you may choose to be transported by ambulance, and it won't be covered by Medicare. In these cases, the company may give you a voluntary ABN. You wouldn't be required to choose an option box because the company expects the trip to not be covered. You'd be responsible for the full cost out-of-pocket.

How much do ambulance services cost with Medicare?

If your trip is covered by Medicare, you'll pay 20% of the Medicare-approved amount. Medicare would pay the other 80%. The Part B deductible also applies.

All ambulance companies are required to accept the Medicare-approved amount as payment in full, so they can't charge you more than 20% of that amount.

In some cases, you may pay more if you're transported to a critical access hospital (CAH), or an entity owned and operated by a CAH.

Every 3 months, you get a Medicare Summary Notice (MSN) in the mail that lists all services billed to Medicare. You can also view your claims online at MyMedicare.gov. On the MSN, you'll see what Medicare didn't pay for the service, as well as why it wasn't paid.

If you believe the trip should have been covered, you can appeal Medicare's decision.

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