Emergency and Non-Emergency Ambulance Services Covered by Medicare

Medicare coverage doesn’t wait until you arrive at the hospital before it kicks in. Medicare can cover ambulance transportation both in emergencies and in some non-emergency situations.

Below is an overview of the various ambulance services that may be covered by different parts of Medicare.

When Does Medicare Pay for Ambulance Transportation?

Ground transportation by ambulance is covered by Medicare Part B and all Medicare Advantage (Part C) plans. There are four requirements that must be met in order for the ambulance ride to be covered:

1. The ambulance must take you to a hospital, critical access hospital or skilled nursing facility.
   
   
2. You must be taken to the nearest such facility that is able to provide you with the care that you need. If you wish to go to a facility that is farther away, Medicare will only cover the cost that would have been required for going to the nearest facility, and you will be responsible for the difference.
   
   
3. The reason for the transportation must be to receive medically necessary treatment.
   
   
4. It must be determined that transportation by any other means could endanger your health. 

Your Medicare costs will include satisfying your annual Part B deductible typically followed by a 20% coinsurance payment for any remaining balance. All ambulance companies typically accept Medicare assignment, meaning they cannot charge you more than the Medicare-approved amount for the cost of your transportation. You may be charged more if taken to a critical access hospital. 

Medicare Coverage of Other Ambulance Transportation

Medicare Part B and Medicare Advantage plans may also provide coverage for ambulance rides by airplane or helicopter if you need immediate and rapid transportation that cannot be provided by a ground ambulance and at least one of the following applies:

1. Your pickup location cannot be easily reached by ground.
   
   
2. Long distances, heavy traffic or other obstacles could prevent ground transportation from getting you the timely care you need. 

Does Medicare Pay for Non-Emergency Transportation?

There are certain cases in which Medicare may cover a non-emergency ambulance ride as long as you have a written order from a doctor stating that the transportation is medically necessary. One example might be if a dialysis patient needs transportation to a dialysis center.

Many Medicare Advantage plans cover non-emergency transportation, sometimes partnering with ride sharing services such as Uber and Lyft. With these plans, you can use your Medicare coverage to pay for a ride to a doctor’s office, pharmacy, rehabilitation center and more. 

What Is an Advance Beneficiary Notice of Noncoverage?

If you receive ambulance services in a non-emergency situation, or if an ambulance company thinks Medicare may not cover your transportation, the ambulance company must provide you with an Advance Beneficiary Notice of Noncoverage (ABN). 

If you sign the ABN, you acknowledge that coverage of the ambulance transportation may be denied, and you might then be responsible for the full cost of the ride. If the ambulance company fails to provide you with an ABN and the claim is denied, you will likely be protected from having to pay. 

How Do You File a Medicare Appeal?

If Medicare did not pay for your ambulance transportation, review your Medicare Summary Notice (MSN), which is mailed to beneficiaries every three months and is also accessible online in your MyMedicare.gov account. Your MSN may provide a reason for why the ambulance ride was not covered, and it may just be a matter of submitting more medical information with the claim. 

As a Medicare beneficiary, you have rights to an appeal of any denied coverage. Your MSN will include instructions for filing an appeal. 

You may also contact Medicare at 1-800-MEDICARE or reference your local State Health Insurance Assistance Program for help.