by Russell Noga | Updated June 21st, 2023
If you’re involved in an accident at home or on the road, you need an ambulance to rush to the scene and take you to the hospital. EMS transportation saves countless lives each year – but it’s not a free service.
A trip in an ambulance could cost you up to $1,200 or more. Still, that’s a small price to pay when your life is on the line.
However, when you leave the hospital and face an astronomical bill for ambulance transportation, you might wish you had taken your car instead.
If you have Original Medicare Part B, you’ll have coverage for ambulance services, saving you thousands of dollars on this healthcare expense.
The problem with Original Medicare Part B is that it only covers 80% of the cost of the ambulance, leaving you to pay the rest of the bill out-of-pocket.
While the 80% saving is significant, the 20% cost could be $250 or more, putting a dent in your retirement savings.
Compare 2024 Plans & Rates
Enter Zip Code
A Medigap Plan Helps Pay for Ambulance
If you have a Medigap plan, you have coverage for the remaining 20% of the bill for your ambulance transportation.
This post examines how a Medigap plan could be your financial saving grace in the event of an emergency trip to the hospital.
Does Medicare Cover Ambulance Transportation?
Original Medicare Part B covers the cost of ambulance transportation in medical emergencies. However, Medicare must deem the use of the ambulance as medically necessary. If you were to have a heart attack at home and require an ambulance to the hospital, that would qualify.
If you were feeling ill with the flu and called an ambulance for a lift to the emergency room, that wouldn’t count as a medically-necessary expense. As a result, Medicare would likely dump the bill on your doorstep, leaving you to pay it.
Ambulance Transportation for Non-Emergencies
Medicare will cover non-emergency ambulance transportation if a medical doctor deems it medically necessary for the patient’s well-being. Typically, the patient will need to be bedridden or require medical services during transport in the ambulance.
The ambulance must take the patient to the nearest facility offering Medicare-approved services, whether a skilled nursing facility, hospital, or another healthcare facility. In some instances, patients may have prearranged ambulance trips several times per month, authorized by their doctor and Medicare.
Medicare is rolling out a new model requiring pre-authorization before a fourth non-emergency ambulance round trip in 30 days. If Medicare doesn’t approve the trip, the patient is liable for the financial costs of calling for the service.
Eight states, including the District of Columbia, have additional rules about non-emergency scheduled ambulance transports. In the District of Columbia, Delaware, North and South Carolina, Maryland, New Jersey, Pennsylvania, West Virginia, and Virginia, patients scheduling three non-emergency ambulance transportation in 10 days must have pre-authorization from Medicare before making the fourth trip.
In non-emergency situations, a private ambulance provider might consider Medicare denying the patient’s claim for coverage. In this case, the ambulance provider must issue the patient with an “Advance Beneficiary Notice of Noncoverage” (ABN), notifying the patient they are responsible for the costs of the service.
Does Medicare Cover Emergency Air Transportation?
Medicare will pay for air-lift to the hospital in emergencies. However, there are specific criteria for this service.
The patient’s health must be in a state where they can’t receive support from a ground-based vehicle ambulance, or the patient is in a location inaccessible to ground ambulances.
It’s also covered if the trip to the hospital in a ground-based ambulance might not get the patient to the hospital in time.
Your Medicare Financial Responsibility for Ambulance Transportation
If you have Original Medicare Part B, you have coverage for 80% of the ambulance transportation costs.
However, you’ll have to pay the remaining 20% out-of-pocket costs. You’ll also need to pay the $226 Medicare Part B deductible in 2023.
If you require transportation to a hospital that is further than the distance to the closest hospital, Medicare only covers the distance to the closest venue.
What If Medicare Rejects Your Ambulance Claim?
If Medicare rejects your claim for emergency or non-emergency ambulance service, the reason for the denial of service is in the Medicare Summary Notice (MSN). In many cases of denial of coverage, it’s due to Medicare not having sufficient supporting documents to authorize the claim.
The hospital or your physician can assist you with collecting the necessary information to resubmit your claim. In some instances, the ambulance service may still need to complete and file the paperwork, or there’s a mistake. If Medicare continues to deny the claim after resubmission, you’ll have to file an appeal.
Does Medicare Supplement Cover Ambulance Transportation?
Medigap policies are supplemental insurance bolstering the protection offered to you by Original Medicare Parts A & B. Ambulance services are a Part B expense, and most Medigap plans provide full coverage for the remaining out-of-pocket costs not covered by Original Medicare.
There are ten Medigap plans, each offering a different level of coverage. Some may cover the cost of the ambulance, while others may not. Speak to a professional Medigap agent about choosing the right Medigap policy to ensure you have coverage for ambulance services.
All Medigap plans offer the following benefits.
- Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
- Part A hospice care coinsurance or copayment.
- Part B coinsurance or copayment.
- Blood transfusion costs for the first three pints of blood.
Plans F, G, and N offer additional Medicare Parts A & B benefits.
- Part A deductible.
- Part B excess charges (Plan N doesn’t cover these charges).
- Skilled nursing facility care coinsurance.
- 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
- Unlimited coverage for all out-of-pocket costs.
Compare 2024 Plans & Rates
Enter Zip Code
Frequently Asked Questions
What is Medicare Supplement insurance?
Get Expert Advice and a Free Consultation on Medigap Plans
Call us at 1-888-891-0229 for a free consultation on Medigap plans. Our fully licensed agents will walk you through everything you need to know about Medigap and how to apply for a policy. If you want us to call you back, leave your details on our contact form. We’ll get you a free quote on any Medigap plan with the best premiums in your state.
Russell Noga is the CEO of Medisupps.com, an online Medicare Agency and resource center helping Medicare beneficiaries learn about Medicare, Medigap and Part D drug plans, and Medicare Advantage plans since 2009. Russell is licensed in all 50 states and has been featured as a keynote speaker, and author of several publications, along with hosting the very popular Medisupps.com Youtube channel.