There are a variety of situations in which you might need some form of ambulance service. If you’re injured in an automobile accident or a serious fall at home, for example, you might need to be rushed to an emergency room. In some cases, though, medical personnel might suggest an air ambulance. Since this is an expensive option, you might hesitate because you’re not sure if Medicare coverage extends to air ambulance services.
Medicare Ambulance Coverage
Whether you have Original Medicare Part A and Part B or are enrolled in a Medicare Advantage Plan, you may have some coverage for ambulance services. As a general rule, the plans strongly favor ground transportation ambulances because the service costs are substantially lower. That being said, Medicare Part B and Medicare Advantage plans will also cover air ambulance services in some cases.
The defining question in terms of Medicare coverage for air ambulance services is this: “Is it medically necessary?” Your care must require immediate and rapid ambulance transportation that ground transportation can’t provide. Medical necessity can look very different to a doctor than it does to Medicare. An example of medical necessity might be if you require a specialized, complex, time-critical surgery.
If your current hospital lacks the equipment or correctly trained surgical staff to perform the surgery, Medicare would probably approve an air ambulance to take you to a hospital that could perform the surgery. In most cases not involving an imminent risk of death, however, Medicare will likely not provide coverage for an air ambulance.
Limitations on Coverage
In extreme emergencies, such as the on-site medical personnel believing your life hangs in the balance, Medicare will likely cover at least some costs for an air ambulance. Beyond that, however, Medicare coverage hinges on pre-approval.
First, a doctor must recommend the air transport as a medically necessary service. Then, the doctor or medical facility must contact Medicare and seek approval for the air ambulance service. If they get approval for the air ambulance, Medicare will provide partial coverage. You are, however, still responsible for a percentage of the cost, and your deductible will apply.
Medicare also places limitations on how far any ambulance can transport you. In the case of an emergency, for example, the ambulance is only allowed to take you to the nearest hospital that can provide the necessary care.
Let’s look at an example: John is in a car accident, and there are two nearby hospitals. A Level II trauma center is eight miles away and a Level I trauma center is nine miles away. Despite the fact that you could receive superior care at the Level I trauma center, a helicopter ambulance can only take you to the Level II trauma center because it’s closer and can provide the necessary care.
Medicare will cover air ambulance services in a very limited set of circumstances. In the event that an air ambulance is the only option or in the case of an emergency, Medicare will likely provide coverage for an air ambulance. A doctor or hospital that wants you transported to another facility by air ambulance for medically necessary care must get approval from Medicare in advance. The air ambulance can only take you to the nearest available facility that can provide the care.