Does Medicare Cover Ambulance Services?
The short answer is yes. If ground or air ambulance transport is medically necessary, Medicare will pay to transport you to the nearest facility that can provide the needed services. Services are provided under Part B. If you do not have Part B, Medicare will not pay.
The Part B deductible, which is $233 in 2022, applies. After that, you pay 20% of the Medicare-approved charges.
Most of the time when ambulance transport is necessary, it is obvious. In cases where it is not, your doctor can provide a certification that it is needed. For example, a dialysis patient may need ambulance transport to a dialysis center.
What If There’s a Question?
If the ambulance service doubts that you meet the definition of medical necessity, they are required to give you a notice that Medicare may not pay. This is called an Advanced Beneficiary Notice of Non-coverage. It is given if you requested an ambulance in a clearly non-emergency situation or the company believes Medicare will not pay. (The fact that you received such a notice, alone, does not mean that Medicare will not pay; this is determined later.)
Are There Special Situations?
Yes. If you live in the states of Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, South Carolina, Virginia, or West Virginia, and you use non-emergency ambulance services more than three times in a ten-day period or once a week for three weeks or more, the company may request a pre-authorization before providing services. If the pre-authorization request is not approved, Medicare will not pay for the services.
