If you or a loved one needed emergency medical transportation, such as a ground ambulance or air ambulance transport, the last thing you need to think about is whether or not Medicare will cover your emergency transportation. In most cases, Medicare should cover your ambulance transportation, here are a few things to keep in mind if you were to be transported!
Medicare Ambulance Transportation Guidelines
Medicare Part B provides Medicare Beneficiaries with ambulance transportation. There are some guidelines with ambulance transportation with Medicare though! In order for Medicare to pay for ambulance transportation there are 3 qualifications that must be met.
It is medically necessary and reasonable to transport you to the hospital.
- If transportation by civilian vehicle could compromise your health, then Medicare will cover a ground ambulance ride to the nearest hospital or medical facility.
- If you could be transported another way, meaning you don’t need medical attention during your transportation and you can safely get to the hospital without risking your health, then Medicare will usually not cover your ambulance ride.
- For Medicare to cover an air ambulance, the location of the emergency must be unable to be accessed by a ground ambulance. If a ground ambulance can access the site but unsafe conditions exist for the crew or patient, Medicare will also approve air transport.
- In some cases, Medicare may pay for limited, medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is medically necessary. An example may be a medically necessary ambulance transport to a dialysis facility for someone with End-Stage Renal Disease (ESRD).
The destination is local.
- As a general rule, the ground ambulance destination must be local, which means that only mileage to the nearest appropriate facility equipped to treat you is covered. If two or more facilities meet this requirement and can appropriately treat the beneficiary the full mileage to any of these facilities is covered.
- If you ask first responders to take you to a facility other than the closet one, Medicare will cover the cost of what it takes to get you to the closest facility and the rest of the bill will be your responsibility.
The facility is appropriate.
- An appropriate facility is an institution that is generally equipped to provide the needed hospital or skilled nursing care for the beneficiary’s illness or injury. An appropriate hospital must have a physician or a physician specialist available to provide the necessary care required to treat the beneficiary’s condition.
How Does Payment Work?
Ambulance expenses are covered under the Medicare Part B. However, you will be responsible for 20% co-insurance. Ambulance companies are not legally able to charge excess charges, so if you don’t have additional coverage you will only have to pay 20% of the total cost.
If you have a Medicare Supplement, you most likely will not have to pay any co-insurance if you have Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan M and Plan N.
If you have a Medicare Advantage Plan, each plan is going to cover a different amount of ambulance transportation. You can either give our team at Senior Benefit Services a call to learn what your plan covers or review your summary of benefits.
If you have questions about your specific situation, please feel free to reach out to Senior Benefit Services. We can help explain your coverage and if you used ambulance transportation, we can help you navigate the claim process. Feel free to give Senior Benefit Services a call at 800-627-2768.