Does Medicare Pay for Ambulance Services?

Medicare coverage for ambulance services is important for many. Understanding how Medicare addresses these transports helps beneficiaries navigate unexpected health events. This article explains when and how Medicare covers ambulance services, including associated costs and the appeal process.

Medicare Ambulance Coverage Basics

Medicare Part B (Medical Insurance) generally covers medically necessary ambulance services. This coverage applies when a beneficiary’s health condition requires immediate medical attention, and other transportation methods would endanger their health. Both ground and air ambulance services can be covered by Medicare under specific circumstances.

Conditions for Coverage

Medicare covers ambulance services when specific criteria are met. Emergency transport is covered for sudden medical crises, severe health risks, or when moving a person is impossible without emergency services. The transport must be to the nearest appropriate medical facility equipped to handle the patient’s condition.

Non-emergency ambulance transport can also be covered under strict conditions. This requires a physician’s written order stating that ambulance transportation is medically necessary because other means would be unsafe for their health. Examples include patients who are bed-confined and unable to get up, walk, or sit in a chair without help, or those needing vital medical services during transport that are only available in an ambulance, such as medication administration or vital sign monitoring. Medicare covers transport to hospitals, critical access hospitals, rural emergency hospitals, and skilled nursing facilities. In some cases, transport to dialysis centers for patients with End-Stage Renal Disease is also covered.

Air ambulance services are covered under more stringent conditions. Coverage is limited to situations where ground transport is not feasible due to distance, terrain, or when the patient’s medical condition necessitates immediate, rapid transport. This applies if a ground ambulance cannot reach an area or if the delay caused by ground transport would significantly jeopardize the patient’s health. Pre-approval from Medicare for air ambulance services is essential, and coverage is for transport to the nearest hospital capable of providing the required care.

Patient Costs and Limitations

When Medicare covers an ambulance trip, beneficiaries incur out-of-pocket costs. After meeting the annual Medicare Part B deductible, which is $257 in 2025, patients are responsible for a 20% coinsurance of the Medicare-approved amount. Most ambulance companies that contract with Medicare are participating providers, meaning they accept the Medicare-approved amount as payment in full, limiting the patient’s financial responsibility to the deductible and coinsurance.

Certain situations lead to non-coverage by Medicare. Transport for convenience, or to a non-covered facility like a doctor’s office for a routine visit, is not covered. Non-emergency transport without a physician’s order or when the patient could safely use other means of transportation, such as a wheelchair van or car, will result in a denial of coverage. If an ambulance provider believes Medicare may deny coverage for a non-emergency transport, they are required to issue an Advance Beneficiary Notice of Noncoverage (ABN), informing the beneficiary of their potential financial responsibility.

Appealing a Coverage Decision

If Medicare denies coverage for an ambulance service, beneficiaries have the right to appeal the decision. The process begins upon receiving a Medicare Summary Notice (MSN), which details the services billed to Medicare and explains denial reasons. The first level of appeal is a redetermination, where a Medicare Administrative Contractor (MAC) reviews the initial claim decision. A redetermination request must be submitted in writing to the MAC within 120 days of receiving the initial determination.

If the redetermination is unfavorable, the next step is a reconsideration by a Qualified Independent Contractor (QIC). This request, made within 180 days of the redetermination decision, should explain why the beneficiary disagrees with the prior decision. Should the QIC uphold the denial, beneficiaries can request a hearing before an Administrative Law Judge (ALJ) if the amount in controversy meets a specific monetary threshold. Further levels of appeal include a review by the Medicare Appeals Council and, finally, judicial review in federal court, each with specific requirements and deadlines. Throughout the appeal process, providing supporting documentation, such as physician’s orders and relevant medical records, is important.