If you have Medicare and need an ambulance, up to 80 percent of your cost will typically be covered. This includes emergency and certain nonemergency services, which may include transportation to treat serious health conditions, such as end-stage renal disease.
Medicare pays 80 percent of the Medicare-approved cost for these services after you have met any deductibles your plan requires.
If your ambulance company charges you more than this amount, you may incur additional charges. However, most ambulance companies accept the Medicare-approved amount.
If you haven’t met your annual Medicare deductible, you’ll have to pay that first, although the Medicare deductible isn’t specifically for ambulance services.
The cost of your ambulance will only be covered by Medicare if transportation in a nonemergency vehicle, such as a car or taxi, would endanger your health.
Medicare typically covers 80 percent of the cost of transportation to the nearest, appropriate medical facility located near you.
If you wish to go to a facility farther away, you may occur additional charges. However, if there is a medical necessity that requires you go to a facility outside your local area, Medicare will usually pay for that service.
If you have a condition that requires regular, nonemergency transportation in an ambulance, you may need an order from your doctor indicating why you need this service in order for Medicare to pay.
There may be a limit on the number of ambulance rides that Medicare will cover per week or per month for nonemergency transportation.
In some instances, you may need prior authorization and approval, either from you or from the ambulance company, before Medicare will pay. These requirements vary from state to state.
To see the specific rules for nonemergency ambulance transportation requirements in your state, call 800-MEDICARE (800-633-4227). If you’re hearing or speech impaired and use a TTY device, call 877-486-2048.
In a nonemergency situation, your ambulance company may provide you with a form called an Advance Beneficiary Notice of Non-Coverage (ABN) so they can charge you if they think Medicare may not pay for your transportation. It’s up to you to decide if you wish to sign the ABN.
If you sign an ABN and incur charges that Medicare won’t pay, you’ll be responsible for paying for that ambulance ride. If you don’t sign the ABN, the ambulance company may decide not to transport you.
Your signature on an ABN is never required in an emergency. Ambulance companies may bill you for services, even if you’re not given or don’t sign an ABN.
If you require emergency medical treatment and can’t be transported to an appropriate medical facility via ground transportation, Medicare may cover 80 percent of the Medicare-approved cost of an air ambulance service. Air ambulances may be helicopters or fixed-wing aircraft, such as airplanes.
Private membership programs, such as Life Flight, require an annual membership fee not covered by Medicare.
If you participate in a program that offers coverage of air ambulance transportation, it may cover the portion of the cost that’s not paid for through Medicare. Some of these programs also cover the cost of ambulatory ground transportation not covered by Medicare.
These programs may be beneficial if you live in a remote, rural area. They may also be helpful if you travel extensively to other countries or locales where appropriate medical care may not be readily accessible.
Situations where an air ambulance is required can include:
- ground transportation can’t get to you
- there’s a significant distance between you and the medical facility you require
- there’s an obstacle between you and the medical facility you require
If you live in a rural area, you may automatically meet the requirements for an air ambulance, provided that your doctor signs an order indicating that either time or distance were obstacles to your health.
If you have Original Medicare, the cost of ambulance services will be covered through Medicare Part B.
If you need medical treatment, including intravenous medications or oxygen during transport, the cost of those treatments will typically, though not always, be included in transport billing and paid for under Medicare Part B.
If you have a Medicare Advantage plan, the cost of ambulance services and the medical care you require during transport will be covered through Medicare Part C.
Medigap policies are sold by private insurance companies. These policies may cover all or part of the costs of ambulance service that Medicare does not cover.
They may also cover the annual deductible for Medicare Part B. You must have Medicare parts A and B in order to be eligible for a Medigap policy.
The type of Medicare plan that’s best for you will be determined, in part, by your known medical conditions, such as heart disease. Since emergencies aren’t typically predictable, it’s hard to say which plan will provide you with the best emergency and ambulance coverage.
Medicare coverage may change annually, so it’s important to keep on top of how the potential costs and benefits relate to you.
Keep in mind: You can change your coverage if you choose to for 2020, or any year, during the annual open enrollment period. The open enrollment period for 2020 starts on October 15 and runs until December 7. The plan you opt into at that time will go into effect on January 1, 2020.
Original Medicare comprises parts A, B, and D. You can opt into some or all of these parts.
If you have Original Medicare, ambulance services will be covered under Part B, should you choose to purchase it.
Part A covers hospital costs, including the ER, but doesn’t cover the cost of an ambulance. Medicare Part A doesn’t require referrals for specialists, so the specialists you may see in an emergency room will typically be covered.
Most people don’t pay for Medicare Part A. However, there’s a deductible required each time you go to an emergency room or are admitted into a hospital. If you have a Medigap policy, it may cover these deductibles as well as other costs.
Part D covers prescription medications, but won’t cover intravenous medications you require in an ambulance or ER. Those drugs will be covered by Part A if they’re administered in a hospital setting, or by Part B if they’re administered in an ambulance or air transport vehicle.
You can choose to have a Medicare Advantage plan instead of Original Medicare. These types of plans are provided through a private insurance company and are federally required to cover everything that Original Medicare does, including ambulance and ER services.
Medicare Advantage plans typically bundle Medicare parts A, B, and D. Medicare Advantage plans require that you enroll in parts A and B and pay the Part B premium.
If you have a medical diagnosis that may require many emergency room visits, a Medicare Advantage plan may make sense for you, since these types of plans have an annual cap on out-of-pocket costs.
Ambulances were once funded by local taxes, but that’s no longer the case in most areas. Ambulance services can be expensive, especially if you have no insurance.
If you have insurance other than Medicare, your policy will indicate what your out-of-pocket cost will be for an ambulance. This can range from hundreds to thousands of dollars.
If you have Medicare, the cost of an ambulance ride is determined by a combination of factors. These include a base payment plus mileage, and services that are rendered during transport. These services can include basic life support or advanced life support.
Air ambulance transport costs can be even higher than ground costs, reaching astronomical sums in some instances.
Choosing a Medicare plan can feel daunting. If your loved one is enrolling in Medicare for the first time, help them determine when their initial enrollment period (IEP) is. For people approaching 65, the IEP begins 3 months prior to their 65th birthday and extends to 3 months after.
There are other periods of time during the year when they can apply or make changes to their current plan.
Help them choose which parts of Medicare they need and whether Original Medicare or a Medicare Advantage plan will be best for them.
helping someone enroll in Medicare
Things to consider include:
- the types of medical services currently needed
- your prediction for the types of services they may need going forward, such as hospice care
- whether their current primary care physician and the specialists they see regularly take Original Medicare or are in a Medicare Advantage network
- the cost of their monthly prescriptions
- their need for dental and vision services
- the amount of money they can afford to spend on deductibles, co-payments, and monthly premiums
You can also help them apply via the phone by calling 800-772-1213 anytime from 7:00 a.m. to 7:00 p.m. on weekdays, Monday through Friday. If you or your loved one is deaf or hard of hearing, call TTY 800-325-0778.
If you prefer, you can help them apply in person at their local Social Security office. An appointment for this type of service is usually required.
Time is of the essence when a medical emergency takes place. Call 911 for an ambulance if:
- you can’t move the person who is ill or injured
- moving them might cause further harm or damage
- you can’t get them to a hospital or medical facility quickly
- the person’s condition appears to be life threatening, including symptoms such as:
- trouble breathing
- profuse or uncontrollable bleeding
- extreme pain
- mental confusion
- suicidal thoughts or threats
There are several types of Medicare plans. Medicare Part B and Medicare Advantage plans cover around 80 percent of ambulance costs. If you or someone else seems to need an ambulance, don’t hesitate to call 911 or your local emergency services.