The last thing you or a loved one want to think about in an emergency situation is whether or not Medicare will cover your ambulance ride.
According to a report from the U.S. Department of Health and Human Services, Medicare paid approximately $5.3 billion for ambulance service claims in 2011 alone. There is no question that this number has risen over the years.
With a staggering number like that, one might assume that ambulance services will always be covered by Medicare. Unfortunately, Medicare’s coverage of an ambulance ride isn’t that cut and dry.
Ambulance Coverage Under Medicare Part B
Medicare Part B provides beneficiaries with their ambulance ride coverage. Like many things with Medicare, there are rules, restrictions, and qualifications that come with obtaining coverage for an ambulance ride.
As an example, for Medicare to cover your ambulance ride, you must be transported to the closest facility that is able to provide you with the medical care you require at the time of the emergency.
However, there are some circumstances where Medicare may cover a further facility. A situation where you could still be covered is if the closest facility cannot provide you with the medical care you need.
If you ask first responders to take you to a facility other than the closest one, Medicare will cover the cost of what it takes to get you to the closest facility and the rest of the bill will be your responsibility.
What You’ll Pay Under Part B
When paying for an ambulance ride under Part B, you will be subject to the Part B annual deductible. As of 2019, the Part B deductible is $185. You will also be responsible for a 20% coinsurance.
Ambulance companies are not legally able to charge excess charges. With no excess charges, they must accept Medicare’s approved price as full payment. This is good news for the beneficiary, you won’t have to worry about paying anything above your 20% coinsurance.
If you have a Medigap plan, you may not have to pay a coinsurance at all. Medigap plans that cover the Part B coinsurance at 100% are Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N (except for a small possible copay).
If you have Plan C or Plan F, your Part B deductible of $185 will also be covered.
It’s important to note that if you are taken to a critical access hospital or taken by an ambulance operated by a critical access hospital, your prices may be different than the above.
Ground Ambulance Rides
If transportation by civilian vehicle could compromise your health, then Medicare will cover a ground ambulance ride to the nearest hospital or medical facility.
If you could be transported another way, meaning you don’t need medical attention during your transportation and you can safely get to the hospital without risking your health, then Medicare will usually not cover your ambulance ride.
Air Ambulance Flights
In the case that you are taken to the hospital by way of airplane or helicopter, Medicare may cover your flight.
For Medicare to cover an air ambulance, the location of the emergency must be unable to be accessed by a ground ambulance. If a ground ambulance can access the site but unsafe conditions exist for the crew or patient, Medicare will also approve air transport.
Non-Emergent Ambulance Rides
Medicare may cover your ambulance ride in a non-emergent case if it is medically necessary.
An example of someone who might qualify for this type of ambulance ride is someone with End-Stage Renal Disease (ESRD). Someone with this condition may need an ambulance ride to get to their dialysis facility.
For this to be covered under Medicare Part B, your doctor must submit a written order stating that you have a medical need for an ambulance ride in a non-emergent case.
The ambulance company must provide an Advance Beneficiary Notice of Noncoverage (ABN) in a non-emergent situation.
Advance Beneficiary Notice of Noncoverage
An ABN is a document explaining that if Medicare doesn’t cover your transportation, you agree to pay the bill. To receive your transportation, you must check off on the document that you understand and still want ambulance transportation, and your signature must be provided.
A patient can choose to forgo transportation if they receive an ABN. However, if you refuse to sign the ABN and still receive transportation, you could be responsible for payment.
A patient will never receive an ABN in an emergency situation.
Voluntary Advance Beneficiary Notice of Noncoverage
In the case where a non-emergent incident occurs and an ambulance is called, the ambulance company may be nice enough to hand you a voluntary ABN. The only difference in this ABN and the one mentioned above is that you aren’t required to sign it.
If the ambulance company hands you a voluntary ABN, they are expecting that Medicare won’t cover the cost.
Does Medicare Advantage Cover Ambulance Rides?
Medicare Advantage plans will cover ambulance rides differently than Original Medicare. In many cases, these private plans will leave the beneficiary owing less than they would with Original Medicare alone.
For instance, an Original Medicare beneficiary is responsible for 20% of the bill along with the Part B deductible. Someone with a Medicare Advantage plan may not have a deductible and may pay something like a $250 copay.
The other option to cut ambulance prices is to enroll in one of the Medigap plans we mentioned above. With Medigap, you will often end up paying nothing out-of-pocket.
To find out how your Medicare Advantage plan covers ambulance rides, you can review your Summary of Benefits.
Don’t Face Medicare Bills Alone
Medicare sends beneficiaries a quarterly Medicare Summary Notice (MSN). The MSN will list out all the medical services that were billed to Medicare during the previous three months.
If you’re a Boomer Benefits client and notice that your ambulance ride wasn’t covered by Medicare according to your MSN, give the client service team a call.
The client service team will be able to find out if Medicare should have covered the bill.
If Medicare should have covered the bill, the client service team will be able to take steps to get the bill covered or have a refund issued to you.
Ambulance coverage can be a tricky situation when it comes to Medicare. Get someone on your side that knows Medicare inside and out, like a Boomer Benefits team member.