Medicare Coverage of Ambulance Services
What It Is
Medicare Part B covers ambulance transportation only under the following limited circumstances:
A patient needs to get to a hospital or skilled nursing facility for medically necessary care.
Any other type of transportation would endanger the patient's health.
Normally, Medicare Part B only covers ambulance services in an emergency, and it doesn't cover transportation to or from a doctor's office. However, if a patient needs nonemergency transportation to or from a hospital or skilled nursing facility, Medicare Part B might pay for it in exceptional circumstances when the patient's doctor certifies that any nonambulance transportation would present a danger to the patient's health.
Note regarding an air ambulance: Medicare Part B covers an air ambulance trip only if travel by land ambulance would present a serious danger to the patient's health.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for ambulance services, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved cost of ambulance services. Ambulance providers can't charge any more than the Medicare-approved amount.
Medicare only pays for transportation to the closest appropriate facility that can provide the care needed. If a patient chooses a facility farther away, Medicare pays based on what it would have cost to go to the closest appropriate facility.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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