Does Medicare Pay for Ambulance Service?

Medicare, a federal health insurance program, covers a wide range of medical services, including ambulance transportation. Coverage depends on medical necessity and the type of transport required.

Understanding Coverage Conditions

Medicare covers ambulance services when they are medically necessary. This means a patient’s health condition at the time of transport must be such that using any other means of transportation would endanger their health.

For emergency situations, Medicare Part B covers ambulance transportation to the nearest appropriate medical facility. This coverage applies when immediate medical attention is required, and an ambulance is the safest and fastest way to reach care. Both ground and air ambulance services can be covered in emergencies if these conditions are met.

Non-emergency ambulance transportation can also be covered, but under stricter conditions. This type of transport is covered if the patient is bed-confined, meaning they cannot get up from bed without assistance, walk, or sit in a chair or wheelchair. Medicare may also cover non-emergency transport if a physician certifies that other transportation methods are medically contraindicated due to the patient’s condition.

Scheduled, repetitive ambulance services for conditions like End-Stage Renal Disease for dialysis treatment may be covered with proper physician certification. Air ambulance services are covered only when ground transport is not feasible due to distance, medical urgency, or obstacles. Medicare does not cover transportation for convenience, social reasons, or when other safe means of transport are available.

Out-of-Pocket Costs

Even when Medicare covers ambulance services, beneficiaries are responsible for certain out-of-pocket costs. Ambulance services fall under Medicare Part B, which has an annual deductible. In 2025, this deductible is $257.

After the Part B deductible is met, Medicare pays 80% of the Medicare-approved amount for ambulance services. The remaining 20% is the patient’s coinsurance responsibility. This coinsurance applies to both emergency and non-emergency transports.

Patients may be responsible for the full cost of ambulance services if Medicare determines the transport was not medically necessary or did not meet coverage criteria. Providers are required to issue an Advance Beneficiary Notice (ABN) in non-emergency situations if they believe Medicare might not cover the service. If you sign an ABN, you agree to pay for the service if Medicare denies the claim.

Medicare Advantage Plans (Part C) must cover ambulance services at least to the same extent as Original Medicare. Their specific cost-sharing structures, such as deductibles, copayments, and coinsurance, can vary.

Billing and Claims Process

Ambulance service providers bill Medicare directly for covered services. After Medicare processes a claim, beneficiaries receive a document called a Medicare Summary Notice (MSN). This notice is mailed every four months if services were received during that period.

The MSN is not a bill, but it provides a detailed summary of services billed to Medicare, the amount Medicare approved, what Medicare paid, and the maximum amount the patient may owe. It is important to review the MSN carefully and compare it with any personal records or receipts. If there are discrepancies or if a claim is denied, the MSN provides instructions on how to appeal the decision.

If a claim is denied or if you believe there was an error, you have the right to appeal. The appeals process has multiple levels, beginning with a redetermination request. You have 120 days from the date you receive the MSN to file an initial appeal.

When appealing, explain why you disagree with Medicare’s decision and provide supporting evidence, such as a doctor’s letter. Maintaining personal records of all medical visits and services received, including ambulance transport, can be helpful throughout this process.