Ambulance services

Medicare Part B (Medical Insurance)covers  ground ambulance transportation when traveling in any other vehicle  could endanger your health, and you need medically necessary services  from a: 

• Hospital
• Critical access hospital, or
• Skilled nursing facility

Medicare may pay for emergency ambulance transportation in an  airplane or helicopter if you need immediate and rapid transport that  ground transportation can’t provide. In some cases, Medicare may pay for limited, medically necessary,  non-emergency ambulance transportation if you have a written order from  your doctor stating that the transportation is medically necessary. For  example, 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.

Your doctor or other health care provider may recommend you get  services more often than Medicare covers. Or, they may recommend  services that Medicare doesn’t cover. If this happens, you may have to  pay some or all of the costs. Ask questions so you understand why your  doctor is recommending certain services and if, or how much, Medicare  will pay for them.

To find out how much your test, item, or service will cost, talk to  your doctor or health care provider. The specific amount you’ll owe may  depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Medicare will only  cover ambulance services to the nearest appropriate medical facility  that’s able to give you the care you need.The ambulance company must give you an Advance Beneficiary Notice Of Noncoverage (Abn)" when both of these apply:

• You got ambulance services in a non-emergency situation.
• The ambulance company believes that Medicare may not pay for your specific ambulance service.

You may now be affected by a Medicare demonstration program if:

• You get scheduled, non-emergency ambulance transportation for 3  or more round trips in a 10-day period or at least once a week for 3  weeks or more
• You get this transportation from any ambulance company nationwide

Under this demonstration, your ambulance company may send a  request for prior authorization to Medicare before your fourth round  trip in a 30-day period. They'll do this so you and the company will  know earlier in the process if Medicare is likely to cover your  services.

If your prior authorization request isn't approved and you continue  getting these services, Medicare will deny the claim and the ambulance  company may bill you for all charges. Either you or your ambulance  company may request prior authorization for these scheduled,  non-emergency ambulance services. 

For more information, call us at  1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.