Does Medicare Pay for an Ambulance?

Medicare, a federal health insurance program, provides coverage for millions of Americans, including those aged 65 or older, certain younger people with disabilities, and individuals with End-Stage Renal Disease. Understanding its provisions for ambulance transport is important for beneficiaries. Ambulance services can be costly, making Medicare’s coverage a frequent concern. This guide explains how Medicare addresses these transportation expenses.

Ambulance Services Covered by Medicare Part B

Medicare Part B covers medically necessary ambulance services. This coverage applies when a health condition is such that using other transportation methods could endanger a person’s health. The ambulance must transport the individual to the nearest appropriate medical facility capable of providing the required care. This includes transport to a hospital, skilled nursing facility, or other facility where medically necessary services will be received.

Both ground and air ambulance services can be covered under Part B. Air ambulance transport is reserved for situations where ground transportation is not feasible due to the need for rapid transport. Coverage requires medical necessity, ensuring the service is needed for the patient’s health and safety.

Emergency Ambulance Transport

Medicare covers emergency ambulance services when a medical emergency requires immediate attention and alternative transportation is unsafe. This means the patient’s health must be in serious danger, and they cannot be transported safely by other means. Examples include heart attack, stroke, or severe injury, where prompt medical intervention is needed.

The destination for emergency transport must be the closest appropriate medical facility that can provide the necessary care. If a closer facility is not equipped to handle a specific medical condition, Medicare may cover transport to a farther facility that can provide specialized treatment. Emergency transport can originate from the scene of an accident or a person’s home, taking them directly to a hospital or other designated medical facility.

Non-Emergency Ambulance Transport

Medicare covers non-emergency ambulance transport under stricter conditions, requiring medical necessity when other transportation methods would compromise a person’s health. A doctor’s order is required, affirming the transport is medically necessary and why alternative transport would be unsafe. This order should ideally be obtained before the transport, or shortly thereafter if unforeseen circumstances arise.

Specific rules apply to repetitive non-emergency ambulance services, such as for dialysis patients. These services often require a physician certification statement confirming the ongoing medical necessity. Medicare may also require prior authorization for certain repetitive non-emergency transports, particularly after a specified number of trips within a given period. This prior authorization helps ensure that services meet coverage rules before they are provided and billed.

Your Financial Responsibility for Ambulance Services

After satisfying the annual Medicare Part B deductible, Medicare pays 80% of the Medicare-approved amount for medically necessary ambulance services. In 2025, the Part B deductible is $257. This means individuals are responsible for the remaining 20% coinsurance and any portion of the deductible that has not yet been met. For ambulance services, providers who accept Medicare assignment agree to accept the Medicare-approved amount as full payment.

Situations where Medicare might not cover ambulance services result in 100% patient responsibility. This occurs if the transport is not deemed medically necessary, if it is to a non-covered facility, or if it is primarily for convenience. If an ambulance company believes Medicare may not cover a non-emergency service, they should issue an Advance Beneficiary Notice of Noncoverage (ABN), informing the individual of potential financial responsibility. Supplementary insurance, such as Medigap policies or Medicare Advantage plans, may help cover the 20% coinsurance or have different cost-sharing rules.

What to Do if Your Claim is Denied

If Medicare denies an ambulance claim, individuals will receive an Explanation of Benefits (EOB) from Original Medicare or a denial notice from their Medicare Advantage plan. This notice will explain the reason for the denial and provide instructions for appealing the decision. Review this document carefully to understand the grounds for non-coverage.

The first step in the appeal process is a “Redetermination” by a Medicare Administrative Contractor (MAC). This involves submitting a written request, often using Form CMS-20027, explaining why you disagree with the denial and including any supporting documentation. If the redetermination is unfavorable, the next level is a “Reconsideration” by a Qualified Independent Contractor (QIC), which can be requested within 180 days of the redetermination decision. Further appeal levels include a hearing by an Administrative Law Judge (ALJ) and review by the Medicare Appeals Council. Keep detailed records of all documents, communications, and submission dates throughout this process. Resources like the State Health Insurance Assistance Program (SHIP) can offer free, objective counseling and assistance with understanding and navigating the appeals process.