A few months ago, I took an
ambulance to the hospital emergency room because I had a nasty fall at home but just received a hefty $1,050 bill from the ambulance company. Doesn’t
Medicare cover ambulance rides?
Frustrated Beneficiary
Dear Beneficiary,
Yes, Medicare does cover
emergency ambulance services and, in limited cases, nonemergency ambulance
services too, but only when they’re deemed medically necessary and reasonable.
So what does that means?
First, it means your
medical condition must be serious enough that you need an ambulance to
transport you safely to a hospital or other facility where you can receive care Medicare covers.
If a car or taxi could transport
you without endangering your health, Medicare won’t pay. For example, Medicare
probably won’t pay for an ambulance to take someone with an arm fracture to a
hospital. But if the patient goes into shock or is prone to internal bleeding,
ambulance transport may be medically necessary to ensure their safety on the
way. The details make a difference.
Second, the ambulance must take
you to the nearest appropriate medical facility. If you choose to be
transported to a facility farther away because the doctor you prefer has staff
privileges there, expect to pay a greater share of the bill. Medicare will only
cover the cost of ambulance transport to the nearest appropriate facility and
no more.
Medicare also may pay for an
emergency flight by plane or helicopter to the nearest appropriate medical
center if the trip would take too long on the ground and endanger your health.
Nonemergency situations
Medicare also may cover
ambulance transportation in some cases when you’re not facing a medical
emergency. But to receive this coverage, your doctor needs to write an order
stating an ambulance is medically necessary because other ways to get you
to an appointment could endanger your health.
For example, if you’ve been
diagnosed with end-stage renal disease, Medicare may pay if you have a doctor’s
order stating it is medically necessary for you to use an ambulance to
take you to and from a dialysis center.
You also need to know that in
nonemergency situations, ambulance companies are required to give you an
Advance Beneficiary Notice of Noncoverage if they believe Medicare may
not pay. This lets you know you will be responsible for paying if Medicare
doesn’t.
Ambulance costs
Ambulance rides can vary from
several hundred to several thousand dollars depending on where you live and how
far you’re transported.
Medicare Part B pays 80%
of the Medicare-approved ambulance rides after you’ve met your annual Part B
deductible ($257 in 2025). You or your Medicare supplemental policy (if you
have one) are responsible for the remaining 20%.
If you have a Medicare Advantage
Plan, it must cover the same services as original Medicare and may offer some
additional transportation services. You’ll need to check with your plan for
details.
How to appeal
If an ambulance company bills
you for services after Medicare denies payment but you think the ride was
medically necessary, you can appeal. Visit www.Medicare.gov and click Providers & Services, followed by Claims, Appeals and
Complaints. To help your case, ask the doctor who treated you for
documentation that you needed an ambulance.
If you need some help, contact
your State Health Insurance Assistance Program, which can help you file an
appeal. Go to www.ShipHelp.org or call 877-839-2675 for contact
information.
