Does Medicare Part A Pay for Ambulance?

Medicare, a federal health insurance program, helps Americans manage healthcare costs. Understanding what Medicare covers, particularly for services like ambulance transportation, is important for beneficiaries. Ambulance services can be complex under Medicare, as coverage depends on the medical situation and the type of transport required.

Medicare Part A’s Role in Ambulance Coverage

Medicare Part A, primarily hospital insurance, has a limited role in covering ambulance services. This part of Medicare generally does not cover ambulance transportation independently. Part A’s coverage for ambulance services is an indirect inclusion, tied to a beneficiary’s inpatient hospital stay or transfers between specific types of facilities.

For instance, if a beneficiary is transferred by ambulance from a hospital to a skilled nursing facility (SNF) and Part A covers the SNF stay, the ambulance transport might be included. Transfers between hospitals could also see ambulance costs covered by Part A if they are part of a continuous inpatient stay and medically necessary.

Medicare Part B Coverage for Ambulance Services

Medicare Part B, which covers medical insurance, is the primary component that addresses ambulance services. Part B covers medically necessary ambulance transportation when using other methods of transportation would endanger the beneficiary’s health. This includes both emergency and certain non-emergency situations, provided specific criteria are met.

For emergency ambulance services, Medicare Part B covers transportation to the nearest appropriate medical facility equipped to handle the patient’s condition. An emergency is defined as a situation where a beneficiary’s health is in serious danger, and an ambulance is the only safe way to transport them. Examples include severe trauma, strokes, or heart attacks where immediate attention is crucial.

Non-emergency ambulance transportation can also be covered under Part B, but with stricter requirements. Coverage applies when a beneficiary needs to be transported to receive medically necessary services, and their medical condition prevents safe transport by other means. A doctor’s order certifying the medical necessity of the ambulance transport is often required, particularly for scheduled, repetitive services.

Air ambulance services, including helicopters and airplanes, are covered by Medicare Part B under specific, limited circumstances. Air transport is considered medically necessary when a ground ambulance cannot provide the immediate and rapid transportation required due to the patient’s condition, or when significant distance or obstacles prevent timely ground transport. This might occur in rural areas or when a patient needs specialized, time-critical care not available locally.

Financial Responsibilities for Ambulance Services

Beneficiaries incur out-of-pocket costs for ambulance services covered by Medicare Part B. After meeting the annual Part B deductible, a coinsurance amount applies to the Medicare-approved service. In 2025, the Medicare Part B annual deductible is $257.

Once the deductible is satisfied, beneficiaries pay 20% of the Medicare-approved amount for medically necessary ambulance services. The ambulance company generally bills Medicare directly for the service. If the ambulance company accepts “assignment,” they agree to accept the Medicare-approved amount as full payment. The beneficiary is then only responsible for the deductible and coinsurance.

Beneficiaries should confirm if the ambulance provider accepts Medicare assignment to avoid higher out-of-pocket costs. If a provider does not accept assignment, they can charge more than the Medicare-approved amount. The beneficiary would be responsible for this excess charge in addition to the coinsurance and deductible.

Navigating Ambulance Billing and Claims

After receiving ambulance services, the ambulance company typically bills Medicare directly. Medicare then processes the claim based on its coverage rules and the medical necessity of the transport. Beneficiaries receive an Explanation of Benefits (EOB) from Medicare, which details the services received, the amount Medicare approved, and the portion the beneficiary is responsible for paying.

Beneficiaries should review their EOB for accuracy. This document outlines what Medicare paid and what remains as the beneficiary’s responsibility. If there are discrepancies or questions about the charges, beneficiaries should contact the ambulance company or Medicare for clarification. Proper documentation, especially regarding the medical necessity of the transport, assists in the claims process.

In certain non-emergency situations, if the ambulance company believes Medicare may not cover the service, they might issue an Advance Beneficiary Notice of Noncoverage (ABN). Signing an ABN indicates understanding that Medicare might deny the claim and that the beneficiary could be responsible for the full cost. This process helps ensure transparency regarding potential out-of-pocket expenses before services are rendered.