Key Take Away:
Medicare covers both ground and air ambulance services with some limitations.
Emergency Service to a foreign hospital is possible.
Non emergency ambulance services can be covered when medically necessary.
If you have a Medicare Advantage Plan you must check the specific benefits of your plan. The cost and benefits will be different than with Original Medicare.
If your Medicare claim is denied, our clients can use our Medicare Advocate services to appeal the denial directly to Medicare.
Does Medicare Cover Ambulance Services?
Yes, Medicare Part B does include coverage for ambulance services, but not without limitations. When does Medicare cover ambulance services? When transporting a patient by ambulance is necessary due to the seriousness of the medical condition and or no other form of transportation was appropriate.
Medicare will cover ambulance transportation to or from a hospital, including a critical access hospital (CAH), or a skilled nursing facility (SNF). Medicare may not cover ambulance transportation if other forms of transportation were available and would not endanger your life or health.
In addition, there are situations when Medicare ambulance coverage includes transporting those with end stage renal disease (ESRD) when the patient needs transportation to a dialysis center.
To Which Medical Facility Will They Send Me?
When Medicare Part B covers ambulance transportation the coverage is not necessarily to the medical facility of your choice. Ambulance services coverage guidelines indicate that Medicare coverage is only to the nearest hospital that is capable of treating you and can provide the care that you need.
If there are no local medical facilities that can provide you the care you need, Medicare coverage will include ambulance transportation outside your local area to the nearest appropriate medical facility. If the patient chooses a different facility, Medicare will only pay the cost for ambulance transportation to the facility that fits their guidelines. The difference in cost between the further destination and the destination preferred by Medicare will be the obligation of the Medicare beneficiary.
When the Medicare beneficiary’s transportation meets the Medicare guidelines, Medicare will pay its portion of the ambulance coverage.
Does Medicare Cover Emergency Ambulance Service
Yes, of course Medicare covers emergency ambulance services. If you have, for example, been in an accident and are bleeding heavily it is critical to get you to the nearest medical facility as fast as possible. Medicare covers transportation to the closest facility even if the closest facility is across a border. If you have an emergency that requires ambulance services, your ambulance trip should be to the closest medical facility that can treat you.
What If the Closest Facility is Outside the U.S.?
Medicare ambulance coverage may include a trip outside the United States. Medicare covers ambulance transportation to a foreign hospital in an emergency situation when the foreign hospital is closer than a hospital within the US.
This can happen when a person lives near an international border, either with Canada or Mexico.
Air Ambulance Transportation
If it is necessary to save your life, Medicare may pay for airplane or helicopter ambulance services. While Medicare does have some rules regarding air ambulance coverage and air transport, the truth is that if you need an air ambulance you will likely be in no condition to negotiate your ambulance trip or pre check to see if Medicare will cover ambulance services in your specific situation.
Emergency technicians would not be expected to call for air transportation in a situation that is not a medical emergency where your location or the distance to a hospital is such that ground ambulance transportation will not suffice.
Non Emergency Ambulance Transportation
There are circumstances where Medicare will cover nonemergency ambulance services. In a non emergency situation Medicare will not cover transportation with an ambulance when an other vehicle would suffice without endangering patient’s health.
When will Medicare cover ambulance transportation in a non emergency situation? When the ambulance service is requested by your doctor stating that ambulance transport is necessary due to your medical condition or a requirement for vital medical services while in transport.
There are situations, even when not an emergency, where your health requires ambulance transportation. For example, ground transportation from the hospital to a skilled nursing facility can be necessary, but not an emergency.
However, knowing non emergency ambulance service can be abused, some states will require the ambulance companies get preauthorization when non emergency ambulance rides amount to three or more trips in a 10-day period or once a week for three weeks or more. Prior authorization in this situation is required in states like New Jersey, Pennsylvania, South Carolina, Maryland, Delaware, D.C., North Carolina, Virginia and West Virginia.
Voluntary ABN Form
When you are receiving non emergency ambulance rides you can expect the ambulance company to request you sign an Advance Beneficiary Notice (ABN) form before providing the service.
What Is An ABN Form?
ABN stands for Advance Beneficiary Notice. The advance beneficiary is required to be completely filled in before being presented to you and will include the expected Medicare approved amount for the service and note indicating why Medicare may not pay for that specific ambulance service.
The ABN will provide you with three choices. You can deny the service, direct the ambulance company to bill Medicare with the promise that you will pay if Medicare does not, or simply request the ambulance company send the bill to you and not bother with Medicare.
With non emergency ambulance transportation it is often standard practice to request a signed ABN form Certainly, if the ambulance company believes Medicare may not pay for the service, they will request a signed ABN form to make certain they are compensated for your ambulance ride.
An ABN is reasonable because they want to be paid if you are denied medicare coverage for their service. If they provide an ambulance ride when you don’t sign an ABN, you will still be responsible for the Medicare approved charge for ground ambulance services.
How Much Does Medicare Pay for Ambulance Service?
Medicare Part B covers ambulance services. The benefits for services that fall under Medicare Part B are that Medicare will pay 80% of the Medicare approved amount after you have paid the annual deductible. Does medicare pay 100% of the ambulance ride? No. But with a supplement you can have 100% of the medical bill covered. See below for more details.
Under some circumstances, you may have a different financial obligation if your ambulance is run by or owned by a Critical Access Hospital (CAH).
It may be important to distinguish that Medicare Part B covers outpatient services like doctor visits and ambulance rides. Medicare Part A covers inpatient services. Together these two parts of Medicare are called Original Medicare and insure you for Medicare covered service in and out of the hospital.
Medicare Part B covers 80% of the Medicare approved charge for the ambulance ride, and may pay the same for the emergency room. However, if you end up as an inpatient in the hospital, Medicare Part A will cover your hospital stay, including the emergency room services.
Does a Medicare Supplement Pay for Ambulance Services?
Medicare supplement insurance goes hand in glove with Original Medicare. The most popular supplements will pay the 20% that Medicare Part B leaves as your responsibility. If Medicare approves the ambulance claim, the Medicare supplement will pay its portion of the bill.
If you are denied Medicare coverage, the supplement cannot pay a benefit.
We strongly suggest talking with an insurance agent or insurance broker to help find the supplement plan that is right for you and the insurance company with a history of price stability. Medigap Seminars can help you with this part of your research. Simply use the Medicare Supplement Quote Request form to provide us the information we need in order to help you.
Medicare Advantage Plan Coverage of Ambulance Services
A Medicare Advantage plan replaces your Original Medicare with a privatized version of healthcare. That means Part B is not involved when you have an Advantage plan. Your Medicare Advantage plan is supposed to cover all the same services of Original Medicare, but that doesn’t mean it covers them at the same rate. In other words, you may pay more for your ambulance services than you would with Original Medicare and their may be even more restrictions on where the ambulance can take you.
There are nearly 4,000 different Medicare Advantage Plans in the United States. Each plan has different benefits, network and cost and any part of that can change each year. You must review the Summary of Benefits that came with your Advantage Plan to find your potential costs and limitations. In addition, you will need to review the benefits each calendar year so you know what to expect if you need ambulance services.
Hospital Indemnity Insurance
You can improve your Medicare Advantage plan coverage for ambulance services, emergency room costs and even your hospital stay with a separate insurance plan called a hospital indemnity insurance. Hospital indemnity insurance pays you the plan benefit in cash, not the medical facility. You can choose the amount of benefit to fit your budget. Most of our clients are surprised at how inexpensive Hospital Indemnity coverage is.
If you would like to explore your Hospital Indemnity Insurance options, please the Contact Us form to reach out to us.
Can Medicare Deny Your Claim?
Medicare covers medically necessary services. In emergency situations, it can easily be argued that an ambulance is medically necessary. Still, Medicare can deny your ambulance claim if they believe or do not have evidence that the use of an ambulance was necessary.
In my opinion, it’s a good idea to seek out a written request from your doctor for non emergency ambulance services prior to receiving the service. Such a request will greatly reduce the possibility of your claim being denied. Especially in situations like transportation to a skilled nursing facility from a hospital or from a skilled nursing facility to home healthcare.
What to Do if Your Ambulance Transportation Claim is Denied?
If you are not already, you should be monitoring your Medicare Summary Notice on a quarterly basis. You can view your Medicare Summary Notice (MSN) on your MyMedicare.gov account whenever you have internet access. The MSN lists all services billed, paid or declined.
Medigap Seminars Medicare Advocate Services
If your claim is denied and you are a current Medicare client of MedigapSeminars.org you can contact our free Medicare Advocate service. We will need a copy of your MSN and possibly other documents like the ABN Our Medicare Advocate can then walk you through the process of appealing the denial and/or help you to understand why it was denied.