Does Medicare Cover an Ambulance?

Medicare often covers ambulance services. This coverage is not universal, however, and depends on specific conditions and the medical necessity of the transport. Understanding these requirements helps individuals navigate potential costs and ensure appropriate care.

General Coverage Criteria

Medicare Part B covers ambulance services when medically necessary. This means other forms of transportation would endanger a person’s well-being. For instance, if a beneficiary cannot be transported safely by car or wheelchair due to their medical state, an ambulance service may be covered.

The transportation must be to the nearest appropriate medical facility capable of providing the necessary level of care for the patient’s illness or injury. This facility could be a hospital, critical access hospital, or skilled nursing facility. Medicare will not cover transport to a facility chosen solely for patient or family preference if a closer, equally capable facility exists.

Types of Ambulance Services Covered

Medicare covers both emergency and non-emergency ambulance services. Emergency ambulance services are covered when a sudden medical emergency requires immediate transportation, and the use of an ambulance is the fastest and safest means. Conditions like a heart attack, stroke, or severe bleeding generally qualify for emergency coverage, where delaying transport could be life-threatening.

Non-emergency ambulance services may also be covered if medically necessary, but typically require a doctor’s order. This order certifies that other means of transport would be medically unsafe for the patient. For example, a patient confined to bed or needing medical services during transport, such as continuous monitoring or IV medication, might qualify. Medicare may cover scheduled, repetitive non-emergency transports, such as for dialysis, if a doctor’s order is obtained in advance.

Both ground and air ambulance services are covered under specific circumstances. Ground ambulance transportation is typically covered when transportation by a personal vehicle would put a person’s health at risk. Air ambulance services, including helicopters or airplanes, are covered for emergencies when ground transport is not feasible due to distance, terrain, or the patient’s critical condition requiring rapid transport not possible by ground.

Medicare may also cover ambulance transport between different healthcare facilities if medically necessary. This includes transfers from a hospital to a skilled nursing facility, or between hospitals if the initial facility cannot provide the required specialized care. Transfers are covered if for a Medicare-covered service or to return after receiving care.

Understanding Your Costs

Beneficiaries are responsible for out-of-pocket costs when Medicare covers an ambulance service. Ambulance services are typically covered under Medicare Part B, meaning the annual Part B deductible applies. For 2025, the Medicare Part B deductible is $257 per year.

After meeting this deductible, beneficiaries generally pay a 20% coinsurance of the Medicare-approved amount for the ambulance service. For example, if the Medicare-approved amount is $1,000, a beneficiary might pay $200 after their deductible is met. The ambulance service provider must be Medicare-approved for coverage to apply.

If services are later determined not to be medically necessary, Medicare may pay less or nothing, leaving the patient responsible for the full cost. In non-emergency situations where the ambulance company believes Medicare may not cover the service, they may issue an Advance Beneficiary Notice of Noncoverage (ABN). Signing an ABN indicates understanding of potential financial responsibility if Medicare denies the claim.

Appealing a Coverage Decision

If Medicare denies coverage for an ambulance service, beneficiaries have the right to appeal the decision. Notification of a denial typically comes through a Medicare Summary Notice (MSN), detailing services billed to Medicare, payments made, and the amount a beneficiary may owe. MSNs are usually mailed every four months if services were received during that period.

The appeals process generally involves several levels, starting with a redetermination. Instructions for filing this initial appeal are provided on the MSN, and it must typically be filed within 120 days of receiving the notice. Include a statement from the physician explaining why the transport was medically necessary, along with any supporting documentation.

Should the redetermination be unfavorable, beneficiaries can request a reconsideration. This request must usually be made within 180 days of the redetermination decision. If the reconsideration is also denied, the next step is typically a hearing before an Administrative Law Judge (ALJ), usually within 60 days from the reconsideration decision. Throughout this process, keeping thorough records of all medical documentation and communication is advisable.