Does Medicare cover my ambulance ride?
Medicare Part B covers emergency ambulance rides and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by any other means. If your trip is scheduled when your health is not in immediate danger, it is not considered an emergency.
Part B covers emergency ambulance services if:
An ambulance is medically necessary, meaning it is the only safe way to transport you.
The reason for your trip is to receive a Medicare-covered service or to return from receiving care.
You are transported to and from certain locations, following Medicare’s coverage guidelines.
And, the transportation supplier meets Medicare’s ambulance requirements.
To be eligible for coverage of non-emergency ambulance services, you must:
Be confined to your bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair).
Or, need essential medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions.
Original Medicare never covers the services of ambulettes, wheelchair vans, or litter-vans. These are wheelchair-accessible vans that provide non-emergency transportation. Medicare also does not cover ambulance transportation just because you lack access to alternative transportation. Medicare Advantage Plans must cover the same services as Original Medicare, and may offer some additional transportation services. Check with your plan to learn about its coverage of non-emergency ambulance transportation.
Note that if you are receiving skilled nursing facility (SNF) care under Part A, most ambulance transportation should be paid for by the SNF. The SNF should not bill Medicare for this service.
Under Original Medicare, Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($185 in 2019). All ambulance companies that receive Medicare payments must be participating providers who accept assignment in all cases.
If you have a Medicare Advantage Plan, contact your plan to learn about the costs of ambulance transportation.
For more information about this and other health insurance questions, please contact the Chautauqua County Office for Aging’s NY Connects Helpline to make an appointment to speak with a certified HIICAP counselor.