Your Medicare Coverage
Is my test, item, or service covered?
How often is it covered?
Medicare Part B (Medical Insurance) covers ambulance services to or from a hospital, critical access hospital (CAH), or skilled nursing facility (SNF). Medicare covers and helps pay for ambulance services only when other transportation could endanger your health, like if you have a health condition that requires this type of transportation.
Medicare will only cover ambulance services to the nearest appropriate medical facility that’s able to give you the care you need. 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.
Emergency ambulance transportation
You can get emergency ambulance 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 some examples of when Medicare might cover emergency ambulance transportation:
- You're in shock, unconscious, or 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 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.
Non-emergency ambulance transportation
You may be able to get non-emergency ambulance transportation if such transportation is needed to or diagnose your health condition and the use of any other transportation method could endanger your health.
In some cases, Medicare may cover limited, medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is necessary due to your medical condition. Even though a situation isn’t an emergency, ambulance transportation may be medically necessary to get you to a hospital or other health facility.
In some cases, Medicare may cover ambulance transportation when you have End-Stage Renal Disease (ESRD), need dialysis, and need ambulance transportation to or from a dialysis facility.
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. 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. 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. What you pay 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 further than the closest one, 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.