FAQ

The answer is yes- but there are some stipulations to coverage. Medicare spells out variations in their medical transport coverage in their website www.medicare.gov/coverage/ambulance-services/.   

To begin with, Medicare Part B (Medical Insurance) covers any emergency ground ambulance transportation when the patient traveling in any other vehicle could endanger their health, and the patient needs medically necessary services from a hospital, critical access hospital or skilled nursing facility. 

In some cases Medicare may pay for limited, medically necessary non emergency ambulance transportation IF:   

1. You have written order from a doctor stating that it is medically necessary transport. (For instance, someone with end-stage renal disease may need medically necessary ambulance transport to a kidney dialysis facility).

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

Sometimes a doctor or other health care provider may recommend services more than Medicare covers and you may have to pay some or all of costs.  It is very important to ask questions- it makes a difference if you have other insurance, how much your doctor is charging,  the type of facility, where you get your test, item or service, or if your doctor is under assignment to accept the Medicare-approved amount as full payment, among other factors. 

Since Medicare will only cover ambulance services to the nearest appropriate medical facility that is able to give the right care, the ambulance company must give an Advance Beneficiary Notice of Noncoverage (ABN) when the service is a non-emergency situation and the ambulance company thinks Medicare may not pay for your specific service.

You will need an ABN for various reasons. For instance, your ambulance company may send a request of prior authorization to Medicare before your 4th round trip if it is in a 30 day period that Medicare stipulates.  If you do not get prior authorization approval and continue getting these transportation services, Medicare will deny your claim and the transport company may bill you for all charges. Once again, www.medicare.gov is your source for information, or you can call with questions at 1-800-MEDICARE (1-800-633-4227) (Medicare, 2022). 

Medicare demonstration programs are demonstration projects that allow the Centers for Medicare and Medicaid Services CMS to test and measure likely effects of potential program changes.  This includes new methods of service delivery, coverage for new types of services, or new payment approaches. You may be impacted by a Medicare demonstration program if you get scheduled for non emergency transport for 3 or more roundtrips in a 10 day period, or if using transport at least once a week for 3 weeks or more. Some states, including California, are affected by Medicare demonstration programs.  So again check with Medicare with questions about coverage before using any transport service. 

There is also a special category of medical air transport with services available for emergency (non-ambulatory) clients in cases of urgent medical care. Due to the immediate nature of the required urgent care, patients or families do not usually know if medical air transport costs fall under their healthcare financial coverage, and are shocked to find out about the costs later.  The NAIC (National Association of Insurance Commissioners) states that the average air ambulance cost for a 52 mile trip falls between $12,000 to $25,000 per flight and can reach up to $6 million depending on medical equipment and maintenance (AirMed, 2017). 

Medicare may pay for such emergency ambulance transport in an airplane or helicopter if immediate and rapid transport is needed and ground transport cannot be provided (Medicare, 2022). Medical air transport services can involve jet ambulances, airline medical escorts or flight nurses, and are transports designed for life support of the client.

**Not Available yet!