When Original Medicare pays for an ambulance
Original Medicare is the plan run by the federal government. Its Part B (Medical Insurance) covers ground ambulance rides when traveling in any other vehicle could endanger your health.
The ride must be to a hospital, critical access hospital, rural emergency hospital or skilled nursing facility for care you medically need. Medicare covers the ride only to the nearest place that can give you the care you need.
In an emergency, Medicare might cover the ride if, for example, you’re in shock, unconscious or bleeding heavily, or you need skilled medical treatment on the way. Medicare may pay for a plane or helicopter ambulance if you need fast transport that a ground ambulance can’t provide.
If Medicare covers the trip, you pay 20% of the Medicare-approved amount after you meet the yearly Part B deductible.
Non-emergency ambulance rides need a doctor’s order
In some cases, Medicare may pay for a non-emergency ambulance ride if you have a written order from your doctor or other health care provider. The order must say the ambulance ride is medically necessary.
For example, someone with End-Stage Renal Disease (kidney failure that needs dialysis or a transplant) may need an ambulance to and from a dialysis facility.
If you get scheduled, non-emergency ambulance rides 3 or more round trips in a 10-day period, or at least once a week for 3 weeks or more, a Medicare prior authorization program may apply. Prior authorization means asking Medicare to approve the rides ahead of time. You or the ambulance company may ask for it. If it isn’t approved and you keep getting the rides, Medicare will deny the claim and the ambulance company may bill you for all charges.
In a non-emergency, the ambulance company may give you a form called an Advance Beneficiary Notice of Non-coverage (ABN). It means the company thinks Medicare may not pay. If you sign it and choose to get the ride, you’re responsible for paying if Medicare doesn’t.
Everyday rides are generally not covered
Medicare generally does not cover non-emergency rides to medical care. If you could safely get to care another way, like by car or taxi, Medicare won’t cover an ambulance.
Medicare’s own coverage guide also says Medicare doesn’t cover rides to or from mental health care services or to a transplant facility. In most cases, Medicare doesn’t pay for rides to a dialysis facility unless an ambulance is medically necessary.
If Medicare doesn’t pay for an ambulance trip and you think it should have, you can file an appeal. Your Medicare Summary Notice explains why the bill wasn’t paid and how long you have to appeal.
Medicare Advantage plans may offer rides
Medicare Advantage Plans are Medicare plans sold by private companies. They may cover some benefits Original Medicare doesn’t. Some plans may cover rides to doctor visits.
These extra benefits are generally limited. Some plans offer benefits only for people with certain chronic illnesses, and you may not learn if you qualify until you join.
To check your plan, read its Evidence of Coverage. This document explains what the plan covers and how much you pay. You can also call the plan, or compare plans with the Find a Medicare plan tool on Medicare.gov.
PACE includes rides to medical appointments
PACE (Program of All-inclusive Care for the Elderly) is a Medicare and/or Medicaid program available in some states. It covers transportation to and from the PACE center and medical appointments.
To join PACE, you must be 55 or older, live in the service area of a PACE organization, need a nursing home level of care (as certified by your state) and be able to live safely in the community with help from PACE.
If you have Medicaid, you won’t pay a monthly premium for PACE. If you have Medicare but not Medicaid, you’ll pay a monthly premium.
If you have both Medicare and Medicaid
Some people qualify for both Medicare and Medicaid. People with full Medicaid coverage may get coverage for services Medicare doesn’t cover, including transportation to medical services.
Medicaid rules and names vary by state. Each state has its own income and resource limits. If your income is limited, you can call your state Medicaid office to find out if you qualify. You can call 1-800-MEDICARE to get your state Medicaid office’s phone number.
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Free help with Medicare questions
Each state has a State Health Insurance Assistance Program (SHIP). A SHIP gives free, personalized help with questions about choosing a health plan, appeals and your Medicare rights.
You can find your local SHIP at shiphelp.org, or call 1-800-MEDICARE to get its phone number.