Does Medicare Cover 911 Ambulance Calls?

Medicare, a federal health insurance program, provides healthcare coverage for eligible individuals across the United States. This program helps Americans manage medical expenses, including those from unexpected health emergencies. Understanding how Medicare addresses emergency services, particularly 911-related ambulance needs, is important for beneficiaries. This article clarifies Medicare’s specific provisions for ambulance services, outlining the conditions under which coverage is provided and the associated financial aspects.

Medicare Coverage for Ambulance Services

Medicare Part B covers ambulance services when medically necessary. This means transportation by ambulance is required because other methods, like a car or wheelchair van, would endanger a patient’s health. This criterion applies to both emergency and, in limited instances, non-emergency situations. An emergency is when a patient’s health is in serious danger and they cannot be safely transported by other means.

Coverage includes transport to the nearest appropriate medical facility, such as a hospital, skilled nursing facility, or dialysis facility. If a patient chooses a farther facility, Medicare covers only up to the cost of transport to the closest appropriate one. However, if no local facility can provide the required care, Medicare may cover transport to the nearest appropriate facility outside the immediate area.

Medicare covers both ground and air ambulance services if medical necessity criteria are met. Air ambulance transport is covered when a patient’s condition requires immediate and rapid transportation that a ground ambulance cannot provide, or if the patient is inaccessible by ground. This includes situations where severe trauma, stroke, or cardiac arrest require faster transport to a specialized facility.

For non-emergency ambulance transportation, Medicare Part B may cover services if medically necessary and a physician provides a written order. This applies when a patient is bed-confined or requires vital medical services during transit that only an ambulance can provide, such as transportation to and from a dialysis facility.

Patient Financial Responsibility for Ambulance Services

For covered ambulance services under Original Medicare, beneficiaries incur out-of-pocket costs. These primarily involve the Medicare Part B deductible and a coinsurance amount. In 2025, the annual Medicare Part B deductible is $257, which a beneficiary must pay before Medicare begins to cover services.

After the deductible is met, Medicare Part B pays 80% of the Medicare-approved amount for ambulance services. The beneficiary is responsible for the remaining 20% coinsurance. For instance, if the Medicare-approved amount is $1,000 and the deductible is met, Medicare pays $800, and the beneficiary owes $200.

Medigap policies, also known as Medicare Supplement Insurance, can help cover these out-of-pocket expenses. These private plans can pay for the Part B deductible and the 20% coinsurance, potentially reducing a beneficiary’s financial responsibility. Specific coverage depends on the Medigap plan type and its terms.

Medicare Advantage and Ambulance Coverage

Medicare Advantage (Part C) plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans must cover at least the same medically necessary ambulance services as Original Medicare, including both emergency and non-emergency transportation.

While Medicare Advantage plans provide comparable coverage, they often have different rules, costs, and network requirements. Beneficiaries might face varying copayments, which could be a fixed dollar amount per trip, such as $245 or $260. Some plans may also require prior authorization for non-emergency ambulance transport, differing from Original Medicare’s guidelines.

Medicare Advantage plans may also have specific network restrictions for ambulance providers. To ensure coverage, beneficiaries might need to use services that are part of their plan’s network. Individuals with a Medicare Advantage plan should review their plan details or contact their administrator to understand their benefits and any associated costs or limitations for ambulance services.

Scenarios Where Ambulance Transport May Not Be Covered

Despite a 911 call, Medicare may not cover ambulance services in specific situations. One primary reason for non-coverage is if the transport is not medically necessary. For example, if a patient’s condition allows for safe transport by alternative means, such as a personal vehicle, Medicare may not cover the ambulance ride.

Coverage may also be denied if an ambulance responds to a 911 call but no transport occurs, such as if the patient refuses transport. Medicare covers transport to a Medicare-approved facility, like a hospital or skilled nursing facility. Transportation to a doctor’s office or a facility not considered an appropriate medical facility for the emergency would not be covered.

If the ambulance provider is not enrolled in Medicare or does not accept assignment, Medicare may not cover the service. In non-emergency situations where the provider believes Medicare may not pay, they must issue an Advance Beneficiary Notice of Noncoverage (ABN) to the patient. Signing an ABN indicates the patient understands and accepts potential financial responsibility if Medicare denies coverage.