Medicare Part B covers ambulance services when it is considered medically necessary and transportation by other means would endanger your health. This coverage may include both emergency and non-emergency ambulance transportation as well as air transportation.

Medicare Coverage for Emergency Ambulance Transportation

If you have a sudden medical emergency and cannot be safely transported via other means, such as a personal vehicle or taxi, Medicare typically covers ambulance transportation to or from one of the following:

• Hospital
• Critical access hospital (CAH)
• Skilled nursing facility (SNF)

All coverage decisions are based on your unique situation. Medicare will likely consider emergency ambulance transportation to be necessary if you are bleeding heavily, in shock, or unconscious. In addition, if your condition requires immediate, skilled medical care, Medicare typically pays for emergency ambulance services.

In general, Medicare ambulance coverage depends on how serious your medical condition is and whether critical care provided en route to the hospital would or could affect the outcome.

When Medicare Covers Non-Emergency Ambulance Transportation

If your doctor provides written notice that you require non-emergency ambulance transportation, Medicare may cover it. One of the more common reasons Medicare beneficiaries need this service is if they have end-stage renal disease (ESRD). This stage of permanent kidney failure often requires dialysis and patients typically need transportation to and from the dialysis facility.

Non-emergency ambulance services may also be covered if alternative transportation could endanger your wellbeing.

Getting Prior Authorization for Scheduled Non-Emergency Ambulance Transportation

In certain states, you may submit a request for prior authorization for non-emergency ambulance services. Guidelines include requiring non-emergency ambulance transportation for at least three round trips in a 10-day period OR once per week for at least three weeks.

Nine locations allow prior authorization:

• Delaware
• Maryland
• New Jersey
• North Carolina
• Pennsylvania
• South Carolina
• Virginia
• Washington, D.C.
• West Virginia

Either you or your ambulance company may submit a prior authorization request. If the request is denied and you continue using the non-emergency ambulance service, Medicare will deny any claims for payment. This would likely leave you owing 100 percent of the cost.

For more information, please call 1-800-MEDICARE (633-4227) or TTY at 1-877-486-2048.

What Is the Advance Beneficiary Notice of Noncoverage?

The Advance Beneficiary Notice of Noncoverage (ABN) is a type of communication a healthcare provider must give you if it believes that Medicare may not pay for a service. Healthcare providers include doctors, durable medical equipment suppliers, and ambulance companies.

If the ambulance company thinks that Medicare may not cover your non-emergency transportation, it must provide an ABN. These notices include options for whether you want the service even if Medicare doesn't cover it. It will also explain what your financial obligation will be if you sign the ABN.

There is also a voluntary ABN that an ambulance company may give you if it is sure Medicare will deny coverage. This is a courtesy service, not a requirement. Voluntary ABNs do not give you any option boxes. It is basically just a notification that Medicare won't pay for the service and that you will be responsible for all charges.

Medicare Coverage for Air Ambulance

Transportation to a hospital via helicopter or airplane may be covered if your condition requires rapid, immediate medical response and ground transportation would endanger your health. Typically, this means one of the following applies:

• Your location is not easily accessed via ground transportation
• The distance that needs to be covered creates a dangerous delay in you receiving critical care
• Obstacles like heavy traffic would interfere with you receiving timely care

Find more information about coverage for ambulance transportation on Medicare.gov here.

How Much Does Medicare Ambulance Transportation Cost?

Assuming Medicare covers the ambulance trip, the 20 percent Part B coinsurance applies. In addition, you must meet your annual Medicare Part B deductible before Medicare pays its share. Your out-of-pocket cost may be different if the ambulance takes you to a critical access hospital.

If Medicare denies coverage for your ambulance service, you will see the item on your quarterly Medicare Summary Notice (MSN). Included will be the reason Medicare denied coverage.

If you don't want to wait for your MSN to arrive, you may also check your Medicare claims on your MyMedicare.gov account. Don't have one? You can create one here.

How to Appeal a Medicare Decision

If Medicare refuses to cover your ambulance trip, you may appeal the decision. But it may be even easier than that. For example, if the ambulance company didn't properly document the reason you required ambulance transportation, you can provide further documentation supporting your claim. Review your ambulance bill, MSN, and other paperwork carefully. You should also talk to your doctor about supporting your claim. The address for sending additional information will be included on the MSN.

It may also be a simple case of incorrect filing on the part of your ambulance company. Ask them to refile.

If your claim is still denied, you may then file an appeal. Start by reviewing the MSN and following the steps it provides. Keep copies of everything you send to Medicare – including information provided by your doctor and the ambulance company.

The first level of appeal is to file a Medicare Redetermination Request Form (CMS Form 20027). Find more information on submitting an appeal here.

Does Medicare Advantage Cover Ambulance Services?

Medicare Part C, more commonly known as Medicare Advantage, must provide the same coverage that you get with Original Medicare (Parts A and B). Therefore, Medicare Advantage plans do cover ambulance services.

Most Advantage plans provide additional benefits as well. You can compare Medicare plans with our Find a Plan tool. Just enter your location to get started.