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Dear Connie,
My friend told me they received an enormous bill after being transported to the hospital. I don’t know how I would survive being hit with this bill. How can they do this to seniors?
So, I’m wondering, does Medicare cover ambulance services? And how can I protect myself from high out-of-pocket costs in case I need emergency care?
This is a great question, and we’re happy you asked us. I’ll do my best to break down Medicare coverage and how you can protect yourself should you need an ambulance or emergency air transportation.
First, yes, Original Medicare Part B does cover ambulance transportation. However, there are requirements. Coverage is only given if traveling in another vehicle could endanger your health, and it’s medically necessary to receive care from a hospital, critical access hospital, or a skilled nursing facility.
For example, Medicare may cover emergency ambulance services if you’re in shock, unconscious, bleeding heavily, or need skilled medical treatment during transportation. These are just some examples.
Agent tip:
“Original Medicare Part B covers a portion of ambulatory services, but you’re responsible for the Part B deductible and 20% coinsurance. Because Original Medicare doesn’t have an out-of-pocket maximum, expenses can add up.“
Original Medicare Part B will also cover emergency airplane or helicopter transportation if your health requires immediate or rapid transportation that ground ambulance transportation can not provide. One of these requirements must apply:
Your pickup location can not be easily reached by ambulance ground transportation.
Obstacles, like heavy traffic or long distances, could prevent you from getting care quickly by ground ambulance.
Of course, if you need emergency ambulance ground or air transportation, that cannot be foreseen or planned. Just as your friend experienced, emergencies can often come with surprise medical bills.
On average, a ground ambulance ride costs $1,200 without insurance. And air ambulance transportation can cost, on average, $38,000.
If you meet the qualifications, Medicare Part B will cover some of these services. You must pay the Medicare Part B deductible plus 20% of the Medicare-approved amount.
For example, if the average cost of emergency ambulance transportation is $1,200, you would be responsible for the Part B deductible and $240 out-of-pocket. In the case of the air ambulance ride, you would pay the Part B deductible and $7,600 out-of-pocket.
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Unfortunately, Original Medicare has no cap on out-of-pocket costs, and we’re not yet including the emergency care you need – only the transportation. That is why many people enroll in a Medicare Supplement (Medigap) or Medicare Advantage plan.
A Medicare Supplement plan can help cover the cost of some or all of the out-of-pocket expenses not covered by Medicare – that 20% coinsurance.
A Medicare Advantage plan offers you a maximum out-of-pocket to shield you from unexpected expenses, provides the same level of coverage as Original Medicare, and frequently offers extra benefits that other plans don’t offer. These extra benefits can include dental, vision, hearing, non-emergency medical ground transportation, and more.
So, if you want to protect yourself from unexpected costs from Medicare or an ambulance company, I recommend exploring Medicare Supplement and Medicare Advantage plans. One of these plans should give you the coverage you need, and that’s right for your budget. They’ll also provide that peace of mind it sounds like you’re looking for.
A local licensed agent can help determine if a Medicare Supplement or Medicare Advantage plan is right for you. Call (623) 223-8884 (TTY: 711) to speak with a Connie Health agent.
At Connie Health, we help you throughout your Medicare journey. If you have any additional coverage questions, please feel free to reach out. We’d be happy to help.
Original Medicare Part B covers emergency ambulance services if traveling in another vehicle could endanger your health, and it’s medically necessary to receive care from a hospital, critical access hospital, or skilled nursing facility.
What is the Medicare-approved amount for ambulance services?
Original Medicare Part B covers emergency and non-emergency ambulance services at 80% of the Medicare-approved amount for participating ambulance company providers. After you meet your Medicare Part B deductible, you pay 20% coinsurance.
The cost of ambulatory services varies by zip code and the need, and there are ways to shield yourself from high out-of-pocket costs.
Original Medicare doesn’t have a maximum out-of-pocket, so you would need to pay 20% of the cost of ambulatory services. A Medicare Supplement plan can help you pay for some or all Original Medicare out-of-pocket expenses. With Medicare Advantage, the maximum out-of-pocket is $8,300 in 2023.
Does Original Medicare cover ambulance services?
Yes, Original Medicare does cover ambulance services.
Original Medicare Part B covers emergency ambulance services if traveling in another vehicle may endanger your health and it’s medically necessary to get care from a hospital, critical access hospital, or skilled nursing facility.
Original Medicare may also cover scheduled or non-emergency ambulance transportation if your doctor provides the ambulance supplier with documentation stating the transport is medically necessary. The order must be dated no earlier than 60 days before the trip.
If you need an unscheduled or irregular non-emergency trip, your doctor must provide a written order no later than 48 hours after the trip.
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.
(623) 223-8884 | TTY: 711
(623) 223-8884 | TTY: 711
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