Medicare Coverage for an Ambulance and other Medical Transportation Services
Typically, Medicare only covers Ambulance services to and from a hospital, critical access hospital (CAH), or skilled nursing facility (SNF), when other transportation could endanger your health. This service is covered under Part B coverage. Medicare will pay 80% of the approved amount. Your Medicare Part D deductible will apply along with 20% coinsurance. The actual cost can differ depending on if a CAH transports you.
Coverage for ambulance or transportation can be a little tricky, so here are some rules that may help:
- Medicare will provide coverage for ambulance services to the nearest medical facility in your local area
- If any facility in your local area cannot treat you, Medicare will cover transportation to the nearest facility outside of your local area that can provide services
- If a facility in your local area can provide service, but you choose to go to one farther away, Medicare will only consider payment based on the charge to the nearest facility in your area.
- Medicare will consider coverage for an Ambulance and other Transportation if you have a medical emergency and your health is in danger because you can’t be safely transported by other means, car or taxi
- If you have End-Stage Renal Disease (ESRD) that requires you to have dialysis and need ambulance transportation to and from a dialysis facility. Medicare will consider coverage for ambulance transportation
- Medicare will consider coverage for Air Transportation, Airplane or Helicopter, if your medical condition requires immediate ambulance transportation and one of the following must apply:
- Ground transportation can’t quickly reach your pickup location
- Long distance or obstacles, like traffic, could prevent you from getting care quickly
- Your doctor can write an order for non-emergency ambulance transportation advising that it is medically necessary
A Medicare demonstration program may affect you if:
- If you are scheduled 3 or more round trips in a ten day period or once a week for three weeks that are not emergency ambulance transportation
- Transportation from an ambulance company out of the following states:
- New Jersey
- South Carolina
- District of Columbia
- North Carolina
- West Virginia
- The ambulance company may send a request to Medicare for prior authorization before your fourth round trip in a 30-day They will do this for your benefit as well as their own. If prior authorization is not approved, Medicare will deny the services. You will be responsible for 100% of the cost.
Always talk to your healthcare provider to see why they are recommending a procedure and how Medicare will cover the service. If Medicare does not cover it, you will be responsible for the cost. The specific amount you might owe depends on several things:
- How much your doctor charges
- Does the doctor accepts assignment
- Type of facility
- If you have other insurance
- Where the test, item, or service is from
Medicare Pathways can help answer any questions or concerns you may have about your Ambulance or Medical Transportation. Give one of our licensed agents a call 866-466-9118 for more information. You can also visit Medicare.gov to learn more about your Medicare coverage.