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In the case of an emergency, Medicare will cover an ambulance ride to the hospital. Medicare only covers non-emergency ambulance transportation in certain situations.
Medicare pays for an ambulance when not taking it would risk your health. Understanding Medicare coverage for ambulance services can prevent an unexpected bill later.
So, in the content below, we’ll discuss the coverage, guidelines, and details of ambulance coverage through Medicare.
Also, we’ll go over other important facts that you’ll need to know.
How to Get Medicare Coverage for Ambulance Services
Medicare pays for an ambulance to take you to the nearest facility that can treat you. Often, that’s 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 special care or if there are no available beds at the closest hospital.
What is the Medicare Approved Amount for Ambulance Services?
The Medicare-Approved amount depends on the state, situation, and specific billing code. For example, the ambulance will likely charge more per mile in rural areas than urban areas.
Also, the bill could be higher when you need care while in the ambulance, such as stabilization.
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. Then, you’ll pay a portion of the costs.
Ambulance companies can’t charge extra fees for services. Not allowing Part B Extra Charges means the ambulance must accept Medicare’s price as payment.
Does Medicare Cover Air Ambulance?
Ambulance coverage includes airplane and helicopter ambulances. Part B will leave you with copays and any applicable deductibles.
You may need an air ambulance if you’re in a remote area, such as hiking in an area that isn’t accessible by ground ambulance.
As with ground ambulances, Medicare covers transportation to the nearest facility that can treat you.
What are the Medicare-approved amounts for international air ambulance services?
Medicare doesn’t usually pay for care outside the United States, including ambulance services. Medicare will pay for international care 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 go outside the United States.
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 records showing the ambulance trip was medically necessary.
Does Medicare pay for non-emergency medical transportation?
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 Non-coverage“.
The record informs you that you’ll pay the full bill.
What is an Advance Beneficiary Notice of Non-coverage?
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. If you refuse to sign the notice but take a ride in an ambulance, you’ll be responsible for the cost.
What is a Voluntary Advance Beneficiary Notice of Non-coverage?
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. So, they’ll give you a form to sign saying you understand.
Does Medicare Advantage Cover Ambulance Services
Medicare Advantage plans have different coverage options for ambulance services. Individuals with Advantage plans often end up owing less than those with Medicare.
You’ll pay the Part B coinsurance and deductible. Advantage enrollees may only pay a copay and have no deductible.
If you’re unsure how your policy works, you may always refer to your Summary of Benefits.
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