When you have an emergency and need to get to a medical facility immediately due to severe illness or injury, ambulance services can get you the help you need as quickly as possible. In the midst of a health crisis, you shouldn’t have to worry about the cost of your transportation, but many people are concerned about the potential out-of-pocket costs for the ride. If you are eligible for Medicare benefits, ambulance services may be covered under certain conditions.
Most individuals qualify for Medicare when they reach 65 years of age, or under 65 due to certain disabilities, and are automatically enrolled in Part A, also known as Hospital Insurance. If you do not enroll in Part B, or Medical Insurance, when you are first eligible, you will likely incur a late enrollment penalty if you enroll later. You will pay a Part B premium and yearly deductible.
The average Part B premium in 2018 is $134, although some people may pay less. After your deductible is met, you will pay 20% of the Medicare approved amount for doctor services, outpatient care, and durable medical equipment (DME). Part B also covers ambulance services under certain circumstances. You may choose to get your Part A and Part B benefits through Original Medicare, administered by the federal government, or through a Medicare Advantage plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans are required to offer the same benefits as Original Medicare, but many offer additional coverage.
Medicare Part B Coverage for Ambulance Services
Part B covers ambulance services to or from a hospital, critical access hospital, or skilled nursing facility only when other transportation could endanger your health. Medicare will cover ambulance services to the closest appropriate medical facility, even if it is outside your local area, but if you choose to be taken to a facility further away, you will be responsible for any expense over the Medicare approved amount of the closest one.
Ambulance services may include air transportation by helicopter or airplane when an individual’s condition requires immediate and rapid transportation that ground transportation cannot provide as long as your pickup location is not accessible by ground or ground obstacles (including long distance or heavy traffic) could stop you from getting the care you need.
When do you need an ambulance?
There are a number of reasons someone will require ambulance services, including, but not limited to:
- You need skilled medical treatment during transportation
- You are unconscious or in shock
- You are bleeding profusely
Your condition must be serious enough that your health would be in danger if you were driven to a medical facility in another mode of transportation.
Non-Emergency Ambulance Services
Medicare Part B will help pay for non-emergency ambulance transportation in some of the following circumstances:
- You have ESRD (End-Stage Renal Disease).
- You need dialysis.
- You need ambulance transport to and from dialysis.
- You have a written order from a doctor stating that ambulance transportation is medically necessary.
If you are taking an ambulance in a non-emergency situation, or the ambulance company believes that Medicare will not pay for your specific ambulance service, the ambulance company must provide you with an Advance Beneficiary Notice of Noncoverage (ABN).