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Does Medicare Cover Ambulance Trips?

  • December 14th, 2004

Medicare provides limited coverage of ambulance services. If you go to a hospital or nursing home by ambulance, the service will be covered only if transportation in any other vehicle could endanger your health.

Generally, this means that Medicare will not cover non-emergency ambulance services, but there are exceptions. For example, Medicare may cover non-emergency ambulance services if the patient is confined to bed and has a written statement from his doctor certifying the medical necessity of the ambulance transportation before he gets the service. (Ambulance providers picking up patients in facilities where they are under the direct care of a doctor may obtain written certifications within 48 hours after transport.) But as a general rule, Medicare will not cover transportation from a hospital or nursing home or to a doctor's office.

In addition, if the ambulance service is to be covered, the vehicle must take you to the nearest facility that can satisfy your medical need. If you choose to go to another facility farther away, Medicare payment is based on how much it would cost to go to the closest facility.

Finally, in all cases a Medicare-certified provider must provide the ambulance transportation. Not all ambulance services are covered by Medicare.

Air ambulance is paid only in emergency situations. If you could have gone by land ambulance without serious danger to your life or health, Medicare pays only the land ambulance rate and you are responsible for the difference. Original Medicare does not cover non-ambulance transportation, although some Medicare HMOs do.

Ambulance coverage is a Medicare Part B benefit. You pay 20 percent of Medicare-approved amounts for the service.

If Medicare refuses to pay for an ambulance trip, you can appeal the denial.For descriptions of cases in which the Medicare Rights Center has advocated for ambulance coverage on behalf of Medicare recipients, visit www.medicarerights.org/searchframeset.htm and type "ambulance" in the search box.

For more on Medicare coverage, click here.

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Last Modified: 12/14/2004

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