Having Medicare coverage for an ambulance in case of an emergency is important. Using an ambulance can potentially save your life, depending on the severity. Without coverage, the costs could be overwhelming.
These services provide some immediate treatment from Emergency Medical Technicians (EMTs) while transporting a patient to a facility (hospital setting) for further treatment.
A report from the U.S. Department of Health and Human Services states “Medicare paid approximately $5.3 billion for ambulance service claims in 2011 alone.” The U.S. population is constantly growing, and more people are enrolling in Medicare health coverage as they become eligible.
In turn, more people are needing ambulance services. 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 additional medical expenses.
Medicare Ambulance Coverage
Emergencies are stressful and difficult for both you and your loved ones. If you need ambulance services, your attention should focus on your health condition, not health coverage.
Beneficiaries may want to know “Does Medicare cover ambulance rides?” Understanding Medicare coverage for ambulance services can prevent an unexpected bill later.
With the number of ambulance service claims being so high in the 2011 report, many people assume that Medicare will always cover costs of ambulance services. While it may be true that, Medicare offers coverage for services even 8 years later; the requirements for qualifying aren’t so black and white.
Ambulance Coverage – Medicare Part B
Original Medicare provides coverage for ambulance rides under Part B. Of course, Medicare has specific rules, restrictions, and requirements to qualify before coverage begins.
For instance, let’s talk about Sandra – she is a Medicare beneficiary who lives by herself. Sandra felt a sharp pain in her chest and immediately dialed 911.
The ambulance quickly arrives, and she is transported to the closest facility for treatment. Sandra notices she’s not at her usual hospital.
Although she is receiving 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.
Soon thereafter, Sandra learns her Medicare Part B plan provides coverage for ambulance services, but restrictions may apply.
Her plan offers coverage for ambulance rides if she’s transported to the closest facility that can provide the proper medical care (including proper medical professionals) she needs for treatment.
She was unable to at the time; but upon request, transportation to a different facility (further away) is optional. Sandra learns when this happens, Medicare will cover the cost of transportation to the nearest facility; however, the remaining balance is the patient’s responsibility.
On the other hand, say Sandra’s emergency was a trauma situation. The ambulance ride to a further facility may be necessary if the closest facility is unable to provide proper medical treatment.
Medicare Part B provides coverage for these transportation services because it’s medically necessary for the patient.
What Do I Pay Under Part B
Part of maintaining your Part B coverage is to pay the plan’s annual deductible. The deductible value is $185 as of January 2019. In addition, you’re responsible for the 20% for coinsurance when paying for ambulance services under Part B.
Ambulance companies legally may not charge additional charges for services. No extra charges or fees means, transportation companies must accept the price Medicare approves as full payment. Following Medicare’s payment beneficiaries are only responsible for the 20% coinsurance. This is great news for many seniors.
Ambulance and Medicare Supplement Coverage
Medigap plans may have a coinsurance amount of $0 depending on the plan type. Plans that cover the cost of your Part B coinsurance in full are Plans A, B, C, D, F, G, M and Plan N.
If you’re taken to a critical access hospital or you receive ambulance services operated by a critical access hospital, your prices may be different.
Part B covers both ambulance and airlifting services, when medically necessary. Moreover, you’re required to pay your annual deductible and 20% coinsurance amount for Part B coverage to continue.
Ground Ambulance Rides
Medicare coverage for ambulance rides to a medical facility close to you is available if transportation by civilian vehicle is a health risk. If you need medical attention on the way to a facility, ambulance services are needed, and Medicare will cover the costs.
On the other hand, if you can arrive at the hospital safely by using other transportation without compromising your health – then ambulance services aren’t medically necessary. Medicare doesn’t provide coverage for the cost of transportation services if you don’t absolutely need it.
Air Ambulance Flights
Sometimes an emergency requires transportation via airplane or helicopter. In the event, an emergency happens in a location that ground ambulance services can’t access, or if the conditions are unsafe for first responders or the patient, air ambulance flights may be necessary.
Medicare pays for services when these circumstances apply.
Non-Emergent Ambulance Rides
Coverage for ambulance rides in non-emergent cases is available when medically necessary. One example is, a patient diagnosed with End-Stage Renal Disease (ESRD) may qualify for this service to get to their dialysis treatments.
Your health-care provider should submit a written order confirming the medical need for ambulance services in non-emergent situations. In such cases, ambulance companies should provide an Advance Beneficiary Notice of Noncoverage (ABN).
Advance Beneficiary Notice of Noncoverage
An ABN is a document stating and explaining that in the event Medicare doesn’t cover your service of transportation, you agree to pay out-of-pocket for the bill.
The document must show you understand, agree, and still want to receive ambulance services. The document is incomplete until you provide your signature. In an emergency, you will never receive an ABN.
You may choose to skip transportation services after getting an ABN. Moreover, if you refuse to sign the ABN 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 is sent to a non-emergent incident, sometimes the ambulance company might give you a voluntary ABN. The difference from a non-voluntary ABN is, the voluntary ABN doesn’t require your signature.
When an ambulance company gives you a voluntary ABN, their expectations are that Medicare won’t cover the costs.
Does Medicare Advantage Cover Ambulance Services
Medicare Advantage plans have different coverage options for ambulance services than Original Medicare. For many, these private plans save the beneficiary money. Individuals with Advantage plans often end up owing less than those with Original Medicare.
For example, comparing the two options for coverage. Original Medicare beneficiaries are responsible for 20% of their bill in addition to the Part B deductible. Meanwhile, Medicare 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 mentioned above. These plans are great, leaving you with no out-of-pocket expenses while providing excellent health coverage and the freedom of seeing the doctor of your choice.
MA plans may provide coverage for ambulance services. If you’re unsure how your plan works, you may always refer to your Summary of Benefits.
CMS has a great resource for Medicare Ambulance Fee Schedule.
Get Help With Ambulance and Medicare Coverage
Medicare will send a quarterly Medicare Summary Notice (MSN) to beneficiaries. The MSN lists all medical services billed to Medicare over the previous 3 months.
Maybe you recently received an MSN showing ambulance services that Medicare didn’t pay for. Don’t worry, give us a call today at the number listed above or fill out a form online.
Our team of licensed Medicare agents is here to help, with no cost to you. Agents can review if Medicare should’ve covered the bill; if so, our team will assist you in taking the proper steps to get reimbursement or have the bill paid.