Having Medicare coverage for an ambulance is essential. Using an ambulance can save your life, depending on the severity. Without coverage, the costs could be overwhelming.
Medicare covers emergency ambulance transportation to a hospital. In certain situations, Medicare will pay for an air ambulance.
But, unless you have supplemental insurance, you can expect to pay part of the bill.
Medicare doesn’t cover every kind of ambulance ride. Understanding the rules can save you money if you can choose to take an ambulance or not.
The U.S. population is growing, and more people have Medicare. In turn, more people need ambulance care.
Over the years, the number of service claims will continue to increase. Individuals should know when the right time to use these services to avoid extra charges.
Does Medicare Cover Ambulance Services
Emergencies are stressful for both you and your loved ones. If you need ambulance services, you should focus on your health, not coverage.
Understanding Medicare coverage for ambulance services can prevent an unexpected bill later.
Part B covers ambulance services when:
- The ambulance must be taking you to or from a facility where you obtain services.
- Ambulance transportation only has coverage when it’s necessary for your health
Medicare Requirements for Ambulance Transport
Medicare only pays for an ambulance if it would endanger your health not to take one.
- If you suffer a heart attack, you need to get to a hospital, and you might need medical care along the way. Medicare would pay for your ambulance.
- But, if you cut your hand and needed stitches, Medicare wouldn’t pay for an ambulance because you could go by car.
Medicare pays for an ambulance to take you to the nearest facility that can treat your condition. Often, that’ll be the closest hospital to the place where you were injured or became ill.
But, Medicare may pay for transport to a more distant hospital if you need specialized care or if there are no available beds at the closest hospital.
How Much Does Medicare Pay for Ambulance Services
Medicare pays for ambulance services the same way it pays for other Part B care. You must first meet an annual deductible. After that, you pay 20% of the cost.
Part of maintaining your Part B coverage is to pay the plan’s premium and an annual deductible. The deductible value is $198 for 2020.
Ambulance companies can’t charge extra fees for services. Not allowing Part B Extra Charges means the ambulance must accept Medicare price as payment.
If you have Medicare Advantage, your costs and deductible will most likely be different. Further, some areas cost more than others.
Tip: Those with a Supplement plan have little to no out of pocket costs. Medigap plans can cover the coinsurances you’d otherwise pay.
Ambulance Coverage – Medicare Part B
Medicare covers ambulance rides under Part B. Of course; there are rules, restraints, and terms to follow.
For instance, let’s talk about Sandra – she is a beneficiary who lives by herself. Sandra felt a sharp pain in her chest, so calling 911 was her immediate reaction.
The ambulance arrives, and she goes to the closest facility for treatment. Sandra notices she’s not at her usual hospital.
Although she is getting proper medical attention, she prefers to be in a familiar setting. After Sandra’s condition is stable, she expresses her concerns to the hospital staff.
Sandra learns her Part B plan provides coverage for ambulance services, but restrictions apply. Her policy covers ambulance rides if she goes to the closest facility that can provide treatment.
On the other hand, say Sandra’s emergency was a trauma situation. The ambulance to a further facility may be medically necessary if the closest facility is unable to provide proper treatment.
Non-Emergency Ambulance Services
Medicare only covers non-emergency ambulance transportation in certain situations. Your doctor must verify that an ambulance is necessary. Meaning you couldn’t travel by another method.
For example, a patient with end-stage renal disease going to a dialysis facility MIGHT qualify for a scheduled ambulance ride to dialysis.
But, if an ambulance operator believes Medicare may not pay, they must give you an “Advance Beneficiary Notice of Noncoverage“. The record informs you that you’ll pay the full bill.
Advance Beneficiary Notice of Noncoverage
An Advance Beneficiary Notice is a document stating that in the event Medicare doesn’t cover your service of transportation, you agree to pay the bill.
The document must show you understand, agree, and still want to receive ambulance services. The form is incomplete until you provide your signature. In an emergency, you’ll never get a notice.
You may choose to skip transportation services after getting a notice. Moreover, if you refuse to sign the notice and you then take a ride in an ambulance, you’ll be responsible for the expense.
Voluntary Advance Beneficiary Notice of Noncoverage
If an ambulance goes to a non-emergent incident, the company might give you a voluntary notice. The difference from a non-voluntary Advance Beneficiary Notice is, the voluntary notice doesn’t require a signature.
When an ambulance company gives you a voluntary notice, they expect that Medicare won’t cover the costs and require you to sign.
How to Submit an Ambulance Bill to Medicare
The ambulance may bill Medicare. Also, you may pay for the ambulance up-front and submit for reimbursement later.
If you need to submit the bill to Medicare, follow these guidelines. Also, be sure to include an itemized invoice and documents showing the ambulance trip was medically necessary.
Medicare Coverage for Ambulance Rides FAQ’s
Does Medicare Cover Air Ambulance?
Ambulance coverage includes airplane and helicopter ambulances. Medicare pays 80% of the cost of travel by air ambulance if air transport is necessary.
Air transport might be needed if:
- You are in a remote location such as a hiking trail that isn’t accessible by ground ambulance.
- It will take a long time to get from your location to the nearest hospital by ground.
As with ground ambulances, Medicare will only cover transportation to the nearest facility that can treat you.
Medicare-approved Amounts for International Air Ambulance Services?
Medicare doesn’t usually pay for care outside the United States, including ambulance services. Medicare will only pay for international healthcare in a few situations.
These include emergencies near the U.S. border, where the closest hospital is in another country. Also, some emergencies on cruise ships and while traveling between the continental U.S. and Alaska.
It may be wise to buy a travel insurance policy if you plan to visit destinations outside the United States.
Does Medicare cover Life Flight?
Life Flight is a membership-based insurance program that pays for ambulance costs in parts of the Pacific Northwest. Medicare doesn’t cover Life Flight’s membership dues.
But, if you’re a Life Flight member and your ambulance meets requirements for coverage, Medicare pays its portion. Life Flight pays after Medicare.
Does Medicare Pay for Transportation?
Ambulances can take patients from one facility to another. Part B may cover this type of transportation, but only if it’s necessary and only to the nearest facility.
If you go to a hospital that can’t handle your situation, Medicare pays for an ambulance to the nearest hospital that can treat you.
So, if doctors determine you need treatment in a burn unit, Part B covers transportation to the closest hospital that has one.
Medicare won’t pay for an ambulance to a different hospital for the ability to be treated by specific doctors or to be close to your family.
Does Secondary Insurance Cover the Cost of an Ambulance When Medicare Does Not?
There are a few types of secondary insurance that may help pay for an ambulance. They include:
- Ambulance insurance, such as Life Flight. Depending on the coverage, these policies may pay ambulance costs even if Medicare doesn’t.
- Travel insurance may cover ambulance transportation in foreign countries. Many travel policies also cover medical evacuations to the United States or another country if you become ill or injured.
- Supplements may cover ambulance rides outside the U.S., subject to certain limits. In the U.S., Medicare Supplements only pay for ambulance trips if Medicare covers them.
Does Medicare Advantage Cover Ambulance Services?
Advantage plans have different coverage options for ambulance services. Individuals with Advantage plans often end up owing less than those with Medicare.
Beneficiaries pay 20% of the bill and the Part B deductible. Advantage enrollees may only pay a $250 copay and have no deductible.
Alternative options for cutting the prices of ambulance services include enrolling in a Medigap plan. If you’re unsure how your policy works, you may always refer to your Summary of Benefits.
CMS is an excellent resource for a Medicare Ambulance Fee Schedule.
Medicare Supplement Plan Provide Coverage for Ambulance Services
Those that have a Medigap policy will pay little to nothing when they need an ambulance or other care for a life-threatening issue. As long as Medicare covers 80%, the Medigap can handle 20%.
Beneficiaries with Medigap coverage can focus on better health, instead of the co-insurance costs of Medicare. Not to mention, the Part A deductible for 2020 $1,408 per benefit period.
Well, there are plenty of Supplement options that cover that huge deductible. We know that as we age our health declines, don’t wait until it’s too late to qualify for Medigap.
Give us a call at the number above and learn more about how Medicare can protect you. Our agents can answer all your questions and walk you through the application for enrollment.
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