Your Medicare Coverage
Is my test, item, or service covered?
How often is it covered?
Medicare Part B (Medical Insurance) covers emergency ground ambulance transportation when you need to be transported to a hospital, critical access hospital (CAH), or skilled nursing facility (SNF). Medicare helps pay for this transportation when you've had a sudden medical emergency, and your health is in serious danger because you can’t be safely transported by other means, like by car or taxi.
These are examples of when Medicare may cover emergency ambulance transportation:
- You’re in shock, are unconscious, or are bleeding heavily.
- You need skilled medical treatment during transportation.
Remember, these are only examples. Medicare coverage depends on the seriousness of your medical condition and whether you could’ve been safely transported by other means.
Medicare may also pay for emergency ambulance transportation in an airplane or helicopter if your health condition requires immediate and rapid ambulance transportation that ground transportation can’t provide, and one of these applies:
- Your pickup location can’t be easily reached by ground transportation.
- Long distances or other obstacles, like heavy traffic, could stop you from getting care quickly if you traveled by ground ambulance.
Medicare will only cover ambulance services (ground or air) to the nearest appropriate medical facility that’s able to give you the care you need.
In some cases, you may be able to get limited, medically necessary non-emergency ambulance transportation if all of these apply:
- Such transportation is needed to obtain treatment or diagnose your health condition.
- The use of any other transportation method could endanger your health.
- You have a written order from your doctor stating that ambulance transportation is necessary due to your medical condition.
In some cases, Medicare may cover ambulance transportation when you have End-Stage Renal Disease (ESRD). There are multiple factors that contribute to whether your ambulance transport is covered for dialysis.
For non-emergency, scheduled, repetitive ambulance services, the ambulance supplier must get a written order from your doctor before you get the ambulance service. The doctor’s written order must certify that ambulance transportation is medically necessary and must be dated no earlier than 60 days before you get the ambulance service.
When you get ambulance services in a non-emergency situation, and the ambulance company believes that Medicare may not pay for your particular ambulance service, it must give you an "Advance Beneficiary Notice of Noncoverage" (ABN).
If you get scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period or at least once a week for 3 weeks or more, from an ambulance company based in New Jersey, Pennsylvania, South Carolina, Maryland, Delaware, the District of Columbia, North Carolina, Virginia, or West Virginia, you may now be affected by a Medicare demonstration program. Under this demonstration, your ambulance company may send a request for prior authorization to Medicare before your fourth round trip in a 30-day period, so you and the company will know earlier in the process if Medicare is likely to cover your services. If your prior authorization request isn't approved and you continue getting these services, Medicare will deny the claim and the ambulance company may bill you for all charges. Either you or your ambulance company may request prior authorization for these scheduled, non-emergency ambulance services. For more information, call 1-800-MEDICARE.
All people with Part B are covered.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount, and the Part B deductible applies. All ambulance suppliers must accept assignment. Medicare's payment may be different if you're transported by a CAH, or by an entity that's owned and operated by a CAH.
If you choose to be transported to a facility farther away, Medicare’s payment will be based on the charge to the closest appropriate facility. If no local facilities are able to give you the care you need, Medicare will pay for transportation to the nearest facility outside your local area that’s able to give you necessary care.
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.