Medicare Part B (Medical Insurance)
covers ground ambulance transportation when traveling in any other vehicle could endanger your health, and you need medically necessary services from a:
- Hospital
-
Critical access hospital
- Rural emergency hospital, or
-
Skilled nursing facility
Medicare may pay for emergency ambulance transportation in an airplane or helicopter if you need immediate and rapid transport that ground transportation can’t provide.
In some cases, Medicare may pay for medically necessary, non-emergency ambulance transportation if you have a written order from your doctor that says the transportation is medically necessary. For example, a patient discharged from the local hospital may need a medically necessary ambulance transport to a skilled nursing facility.
Your costs in Original Medicare
After you meet the Part B
deductible
, you pay 20% of the
Medicare-Approved Amount
.
Frequency of services
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.
Find out cost
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
- Other insurance you may have
- How much your doctor charges
- If your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service
Things to know
If using other transportation could endanger your health, Medicare will only cover ambulance services to the nearest appropriate medical facility that’s able to give you the care you need.
The ambulance company must give you an "
Advance Beneficiary Notice of Noncoverage (ABN)
" when both of these apply:
- You get ambulance services in a non-emergency situation.
- The ambulance company believes that Medicare may not pay for your specific ambulance service.
You may now be affected by a Medicare demonstration program if:
- You get scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period or at least once a week for 3 weeks or more
- You get this transportation from any ambulance company nationwide
Under this demonstration, your ambulance company may send a request for prior authorization to Medicare before your fourth round trip in a 30-day period. They'll do this so you and the company will know earlier in the process if Medicare is likely to cover your services.
If your prior authorization request isn't approved and you continue getting these services, Medicare will deny the claim and the ambulance company may bill you for all charges. Either you or your ambulance company may request prior authorization for these scheduled, non-emergency ambulance services. For more information, call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.
