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Is Ambulance Transportation Covered in Medicare?

Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part B covers ambulance services in emergency situations and covers non-emergency services in limited situations. People need to understand what is and isn’t covered and how much they have to pay to secure ambulance services.

Emergency Services

Those who need emergency services are covered under Medicare Part B. Four criteria must be met for the coverage to kick in.

  1. The ambulance must be medically necessary. That means it is the only safe way to transport the patient.
  2. The patient must be going to a hospital to receive a Medicare-covered service or returning home from the hospital after receiving such care.
  3. The patient must be transported to or from a Medicare-approved location. Approved locations are:
    1. The nearest hospital or skilled nursing facility (SNF) that offers Medicare services
    2. From the hospital or SNF to home, as long as the hospital or SNF is the closest facility that offers Medicare services
    3. From an SNF that is unable to provide treatment to the nearest approved medical facility
    4. From home to the nearest renal dialysis facility
    5. From the nearest renal dialysis facility to home
  4. The ambulance company must meet Medicare’s ambulance requirements for the patient to qualify for coverage.

Non-Emergency Services

In some cases, Medicare covers non-emergency ambulance services. Those who cannot get up from bed without assistance and are unable to walk or sit in a wheelchair are eligible for ambulance services. Also, those who require medical care that they can only receive in the ambulance can get coverage.

Medicare may also cover unscheduled irregular and scheduled regular ambulance trips, but a doctor’s written order is required. The order should be received 48 hours prior to non-emergency trips. It is important to check with Medicare after receiving the doctor’s order to make sure the trip will be covered.

Ambulance Transportation in an Airplane or Helicopter

Medicare Part B also covers ambulance transportation via an airplane or helicopter in certain cases. It is covered when patients require rapid and immediate transportation to a medical facility, and ground transportation won’t be fast enough. Again, patients must go to a Medicare-approved facility.

Costs for Patients

Medicare Part B only covers 80% of ground and air ambulance transportation costs. Patients have to shoulder 20% of the Medicare-approved amount for transportation. They are also required to pay the Medicare Part B deductible.

Those who have other insurance might not have to pay these extra fees. People should talk to their insurance companies to determine how much their other insurance covers.

Choosing Coverage

People can save on costs by ensuring they have all the coverage they need. That might include Medicare Advantage or Medicare Supplemental coverage. Americans can compare their coverage options online or call 844-236-0228 to speak to a licensed insurance agent. Speaking to an agent is the best option for those who want to make sure they get ample coverage for all their needs.