Does Medicare Cover Ambulance Transportation?

Medicare covers ambulance transportation under specific circumstances. Ambulance services are generally covered by Medicare Part B, which is medical insurance, when they are considered medically necessary. This applies to situations requiring emergency medical transport or when a beneficiary needs to be moved to a medical facility for necessary treatment.

General Coverage Principles

Medicare’s coverage for ambulance services hinges on “medical necessity.” This means a beneficiary’s health condition must be such that using any other transportation method would endanger their health. For instance, if a person’s condition requires professional medical services or supervision during transit, an ambulance is considered medically necessary.

The ambulance transport must also be to the nearest appropriate medical facility that can provide the necessary care for the patient’s illness or injury. Medicare typically covers transportation to a hospital, critical access hospital, or skilled nursing facility. If a beneficiary chooses to go to a facility farther away, Medicare will only cover the cost up to the nearest appropriate facility, leaving the beneficiary responsible for the additional mileage charges.

The determination of medical necessity is based on the patient’s condition at the time of transport, not merely the ambulance’s response. While a physician’s order can support medical necessity for non-emergency transports, its presence or absence does not solely prove or disprove medical necessity. All ambulance services must meet Medicare’s program coverage criteria.

Specific Covered Transportation Types

Medicare distinguishes between emergency and non-emergency ambulance transportation. Emergency ambulance services are covered when a sudden medical emergency requires immediate medical attention, and an ambulance is the fastest and safest means of transport. Examples include heart attacks, strokes, severe injuries, or profuse bleeding where other transport means would jeopardize health.

Non-emergency ambulance transportation may also be covered under stricter conditions. This service is covered when a beneficiary needs transportation for medically necessary services, such as scheduled medical appointments or dialysis, and their medical condition makes other methods unsafe. For non-emergency transport, a physician’s written order certifying medical necessity is often required, sometimes with prior authorization.

Both ground and air ambulance services can be covered by Medicare. Ground ambulance transport is standard. Air ambulance services are covered only when ground transportation is not feasible due to distance, terrain, or the patient’s medical condition demanding rapid transport. For instance, if a patient requires immediate evacuation from an area inaccessible by ground ambulance, air transport may be covered.

Your Share of Costs

When Medicare covers ambulance services, beneficiaries share in the costs. These services fall under Medicare Part B. The annual Part B deductible must be met before Medicare pays. For instance, in 2025, the Medicare Part B deductible is $257.

After the deductible is satisfied, Medicare pays 80% of the Medicare-approved amount for ambulance services. The beneficiary is responsible for the remaining 20% coinsurance. For example, if the Medicare-approved amount for an ambulance service is $1,000, and the deductible has been met, the beneficiary would typically owe $200.

Ambulance service providers should accept “assignment,” meaning they agree to accept the Medicare-approved amount as full payment. If a provider does not accept assignment, they may charge more than the Medicare-approved amount, and the beneficiary could be responsible for the difference, known as “excess charges.” Some beneficiaries have supplemental insurance, such as Medigap policies or Medicare Advantage plans, which may help cover these out-of-pocket costs, including the deductible and coinsurance.

Situations Not Covered

Medicare does not cover all ambulance transportation. Services rendered solely for a patient’s convenience or when other, less costly transportation methods could be safely used are not covered. This includes situations where a patient could safely travel by car or taxi without endangering their health.

Transportation to a facility that is not a hospital, skilled nursing facility, or other Medicare-covered medical facility is excluded from coverage. For example, Medicare will not pay for transport to a doctor’s office for a routine visit if it’s not medically necessary. Similarly, local transport between non-medical residences or for non-medical reasons is not covered.

If an ambulance service provider believes Medicare may not cover a specific service, they should issue an Advance Beneficiary Notice of Noncoverage (ABN). This form informs the beneficiary that Medicare might deny the claim, making the beneficiary responsible for the full cost. Signing an ABN signifies the beneficiary’s understanding and agreement to pay if Medicare denies coverage. However, an ABN is generally not required in emergency situations where the patient is under duress.