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Medicare Part B does cover medically necessary ground transportation, including ambulance services.
Medicare Part C, or Medicare Advantage, plans also offer this same coverage and may provide additional benefits.
The cost of being transported to the hospital by ambulance is something that people tend not to think about until after it happens. At the time emergency service is needed, the only thing that matters for seniors is to get to the hospital safely. But billing is another matter entirely.
This article describes how Medicare pays for ambulance costs under Medicare Part B and Medicare Advantage, defines what medical necessity means, and explains the different coverage options available under Medicare.
Medicare does cover ambulance rides under Medicare Part B, referred to as ambulance services. Under Part B, you will be required to pay 20% plus your deductible for ambulance services. Medicare only covers medically necessary ground transportation. This includes transport to:
These trips are covered in an emergency and whenever transportation is deemed necessary to a facility for reasons related to your health. If for some reason an ambulance or other vehicle cannot provide ground transportation in an urgent situation, Medicare may also pay for transportation by helicopter or a plane.
Medical necessity is a term that comes up often during discussions about insurance coverage. This criteria is particularly important to keep in mind for an ambulance ride. Ambulance trips are covered by Medicare Part B as long as they relate to a medical necessity, and are considered necessary for the treatment of an illness or injury.
Your doctor or another health care professional makes the determination for what is medically necessary. This does not mean that Medicare will always pay for a medically necessary service. There are limits to coverage and charges, and if Medicare declines to pay, the cost may be covered by other types of insurance.
Likewise, people can request non-urgent ambulance rides for transportation in addition to emergency rides. Non-urgent rides may also be covered by Medicare under certain circumstances.
Medicare Part C, also known as Medicare Advantage, is Medicare coverage provided by private insurance. It includes the same coverage provided by original Medicare Part A and Part B. In addition, Medicare Advantage plans also often offer additional benefits like vision, dental, and hearing coverage. Prescription drug coverage is also a potential benefit of Medicare Advantage. Plans are offered by private health insurance carriers, and benefits may vary depending on the plan. Choosing Medicare Advantage over Original Medicare is a decision that should be based on what coverage is right for you.
Medicare Advantage plans do cover the cost of ambulance trips in the same way they are covered by Medicare Part B, and may also provide additional coverage. The transport and medical care received during the ride is billed through the Medicare Advantage plan.
Some Medicare Advantage plans also cover the cost of non-emergency transportation to and from doctor’s offices. Some rideshare companies have even partnered with certain insurance companies and plans to transport patients to pharmacies, clinics, and doctor’s offices to help patients arrive at their appointments when they lack the public transportation to do so.
Search and compare Medicare Advantage plans in your area! If you need help finding the coverage that’s right for you, give us a call at (800) 950-0608 for assistance from a licensed insurance agent.
Under Medicare Part B, ambulance transport will take you to the nearest hospital or skilled nursing facility depending on what is most appropriate. The service area that Medicare covers does include hospitals that may be outside of your city or town if the hospital in question is larger and serves your area, or it is more equipped to handle the care you need than a closer facility.
In non-emergency situations, Medicare will cover the cost of ambulance trips if it’s necessary for the diagnosis or treatment of your health condition, your doctor writes an order stating that it is necessary, and you cannot be transported by car, taxi, or public transport.
When you receive ambulance services in a non-emergency situation that does not meet Medicare requirements or the company providing the transportation believes that Medicare may not cover the cost of the transportation, they will provide you with an Advance Beneficiary Notice of Non-Coverage.
If you have questions about Medicare Part B or Medicare Advantage coverage, call us at (800) 950-0608. We’ll be happy to help you find coverage that fits your needs.