Does Medicare Pay for 911 Ambulance Service?

Understanding Medicare’s coverage for 911 ambulance services is a common and important question for beneficiaries. This article clarifies when and how Medicare covers ambulance services, including those initiated by a 911 call.

Medicare Part B Coverage for Ambulance Services

Medicare Part B, which is medical insurance under Original Medicare, covers ambulance services. This includes transportation initiated by a 911 call, provided the services are deemed medically necessary. Medicare Part B covers emergency ambulance transportation when a beneficiary’s health condition requires immediate medical attention and using an ambulance is the safest and fastest means of transport.

This coverage extends to both ground and air ambulance services, ensuring beneficiaries can reach the appropriate medical facility. After meeting the annual Part B deductible, Medicare pays 80% of the Medicare-approved amount for these services. The beneficiary is then responsible for the remaining 20% coinsurance.

Conditions for Coverage

Medicare covers ambulance services primarily when they are medically necessary. This means a beneficiary’s medical condition is such that using any other method of transportation would endanger their health. For instance, if a person is unconscious, experiencing heavy bleeding, or requires skilled medical care during transit, ambulance transport is considered medically necessary.

The ambulance must transport the patient to the nearest appropriate medical facility capable of providing the necessary care. If a beneficiary chooses to go to a facility farther away, Medicare will only cover the cost of transport to the closest appropriate facility. The beneficiary is responsible for any additional mileage. In situations where ground transportation is not feasible due to distance, traffic, or the patient’s rapidly deteriorating condition, air ambulance services may be covered.

While 911 calls signify an emergency, the medical necessity of the transport is assessed. Medicare also covers certain non-emergency ambulance transports if a doctor provides a written order stating that other transportation methods would be medically unsafe. This can apply to individuals who are bed-confined or require medical services during transport, such as dialysis patients needing transportation to and from treatment.

Understanding Costs and Billing

Even with Medicare coverage, beneficiaries are responsible for certain out-of-pocket costs for ambulance services. After meeting the annual Medicare Part B deductible, which is $257 in 2025, beneficiaries pay a 20% coinsurance of the Medicare-approved amount. The “Medicare-approved amount” is the amount Medicare sets as the full charge for a covered service.

Ambulance services that “accept assignment” agree to accept the Medicare-approved amount as full payment. This means they cannot charge the beneficiary more than the deductible and coinsurance. Most ambulance companies accept assignment, which limits the beneficiary’s financial responsibility.

For beneficiaries enrolled in a Medicare Advantage (Part C) plan, ambulance services are covered, as these plans must offer at least the same benefits as Original Medicare. However, cost-sharing amounts, such as copayments or coinsurance, and network rules may differ, so checking the specific plan details is important. Supplemental insurance policies, known as Medigap plans, can help cover the 20% coinsurance and, in some cases, the Part B deductible, significantly reducing out-of-pocket expenses.

If an ambulance claim is denied, beneficiaries have the right to appeal the decision. The process begins with requesting a redetermination after receiving the Medicare Summary Notice (MSN). It is helpful to provide supporting documentation, such as a statement from the treating physician explaining the medical necessity of the transport. The appeal process involves several levels, and beneficiaries should adhere to the specified deadlines, such as 120 days for the initial appeal.