In some cases, Medicare absolutely covers ambulance costs. In others, it doesn’t. We’ll review the guidance provided by the Centers for Medicare and Medicaid Services (CMS)  on whether or not Medicare covers ambulances for the elderly. 

Does Medicare pay for an ambulance?

Yes! According to CMS, Medicare covers ambulances. It does so in certain situations and with some caveats, so pay close attention to those. 

Generally, Medicare covers ambulance rides when: 

1) not using an ambulance will harm you and 

2) you need medically necessary services from specific kinds of emergency medical facilities. 

Medicare may also cover medically necessary but non-emergency ambulances when prescribed by your doctor. 

The thing in common between all these situations is the requirement of Medicare’s medical necessity for ambulance transport. 

Medicare ambulance coverage also only covers taking you to the closest possible facility that can meet your care needs. 

Does Original Medicare cover ambulances? 

You may be wondering how Original Medicare covers ambulances. Is it Medicare Part A or Part B that covers ambulances? Does it matter if I’m admitted to the hospital or not?

Does Medicare Part A cover ambulances?

Medicare Part A does not cover ambulances. Medicare Part A covers hospital services. Most ambulance services are not owned by hospitals and therefore do not qualify for Part A coverage. 

Instead, Medicare coverage of ambulance transportation happens via a different part of your plan. 

Does Medicare Part B cover ambulance service?

Medicare Part B is actually the part of Medicare that provides medicare ambulance coverage. Medicare ambulance billing doesn’t cover 100% of your ride, though. Once you meet your deductible, you pay 20% of the Medicare-Approved amount. 

Does Medicare cover emergency ambulances?

Yes! Medicare Part B primarily provides Medicare coverage of ambulances in emergencies. It will even cover air transport in very exotic situations where ground transportation is injurious to your health.

Does Medicare cover non-emergency medical transportation?

Yes, but only in some cases. As outlined above, your provider needs to demonstrate to Medicare the medical necessity for ambulance transport. Your doctor must provide a written order or prescription for it. 

However, just because you have an order for medically necessary services doesn’t mean that Medicare will cover your ambulance trip. In some cases, Medicare may determine your ambulance trip is actually not medically necessary or that it isn’t medically necessary in the volume prescribed by your doctor. 

In the event the ambulance company believes Medicare won’t cover ambulance costs, then the ambulance company must provide you with an Advance Beneficiary Notice of Noncoverage (ABN). Your ambulance provider will send a request for preauthorization to Medicare. 

Always consult with your doctor, ambulance provider, and other insurance to determine whether or not you qualify for Medicare coverage of ambulance transportation and what your out-of-pocket costs may be. 

What is the Medicare-approved amount for ambulance services?

The Medicare-approved amount for covered ambulance services is 80% of the costs, after your Part B deductible. You’ll be required to pay the remaining 20%. 

What happens if Medicare doesn’t pay for an ambulance?

You’ll receive a Medicare Summary Notice (MSN) for the Medicare ambulance billing denial. Review that document carefully. While it might demonstrate that the trip wasn’t covered, it may also demonstrate that the ambulance company failed to fully document the reasons for your transportation or that the proper paperwork wasn’t filed. If either of those is the case, you’ll want to speak to the ambulance company or your provider. 

Medicare may also determine that there wasn’t a Medicare-defined medical necessity for ambulance transport. Namely, 1) that some other method of transport could have worked or 2) you didn’t need as many ambulance trips as ordered. 

If Medicare doesn’t cover your ambulance ride, you have the ability to appeal the decision. The MSN will have instructions for how to file an appeal. Follow those to the letter. Also, speak with your provider and the ambulance company to gather supporting documentation for your appeal. 

Medicare requirements for ambulance transport

As highlighted above, the requirements for emergency and non-emergency Medicare ambulance transport are different. Those differences exist because of the divergent needs for emergency and non-emergency transport. 

There are two requirements for emergency Medicare-covered ambulance transport:

1) other forms of transport would harm your health and

2) you’re being transported to a hospital or skilled nursing facility.

While the ambulance company will be able to determine the second, the first is somewhat more difficult to define. Medicare provides some examples of what would qualify for health conditions making non-ambulance travel harmful to your health. One example is that you’re in shock, unconscious, or bleeding heavily. The other is that you need skilled medical treatment during transportation. 

Unfortunately, the determination for the propriety of Medicare covering ambulance costs is made in hindsight. While you or people around you might think something is urgent at the moment, Medicare may later determine it wasn’t. 

For non-emergency transport, you must have: 1) a doctor’s order for ambulance transport and 2) your health must be endangered by other forms of transport. Medicare provides an example of an end-stage renal failure patient needing dialysis service. 

Again, like emergency care, this evaluation can be done in hindsight. However, the non-emergency quality of these services means that the ambulance service can try to get the services pre-authorized, or pre-approved by Medicare for payment. 

Conclusion

Medicare provides a few different options for ambulance services and payment for those services. Whether or not you qualify for those services depends on the severity of your medical need and the availability of alternative transport. Medicare will make that decision based on the totality of information available to them – which might be different from your and the ambulance company’s determination at the moment. 

You should speak to your healthcare provider and your plan provider to determine what’s best for you and when you should and shouldn’t use an ambulance. Unless you can anticipate and take on the costs of ambulance services, they can be unexpected and financially impactful.

Questions about Medicare?

Shoot us an email at medicare@hihella.com.