Introduction
Medicare is a program that helps older adults and people with disabilities pay for health care services. Part A of Medicare, which covers hospital services, typically doesn’t cover ambulance transportation. But Medicare Part B (which provides outpatient care) does pay for emergency ambulance service if you have a condition that requires it—and sometimes even when you don’t.
Let’s take a closer look at both scenarios: what conditions qualify as an emergency and how Medicare pays for them, as well as how to tell if your ambulance ride would be covered under Part A or B of the program.
Medicare Part A covers ambulance services in certain cases.
Medicare Part A covers ambulance services in certain cases. You must meet the requirements for Medicare Part A, which include:
- Original Medicare or a Medicare Advantage plan. If you have Original Medicare, it’s paid for by Social Security and requires no out-of-pocket expenses to receive benefits. If you have a Medicare Advantage plan through a private insurance company, that company pays all or part of your medical bills while you’re covered under their plan.
- Being enrolled in Part A (hospital insurance). This means paying monthly premiums and having 60 days of hospital coverage per year without paying more money into the system.
Medicare Part B covers ambulances in some cases.
The short answer is no, Medicare does not cover ambulance services. But don’t let that discourage you from calling for an ambulance in an emergency situation.
Medicare Part B will cover ambulance service when it is considered medically necessary. In other words, when your doctor orders transportation by ambulance to the hospital or clinic due to your illness or injury they can bill Medicare directly for the cost of their service. If this happens, you will not be responsible for any copayments or deductibles that are part of your health insurance plan (such as those outlined below).
However, if someone calls 999 and requests an ambulance because they feel ill enough that they need medical attention but aren’t sure what’s wrong with them, Medicare won’t pay for the ride—even though many times these rides prove to be unnecessary and end up costing taxpayers money.
Emergency vs. Non-Emergency Ambulance Coverage
Medicare does not cover non-emergency ambulance services. However, Medicare Part B may cover some emergency ambulance rides in certain circumstances. Here’s what you need to know:
- If you call an ambulance to transport you to the hospital (or out of a hospital), this is a covered service under Part B. An example would be if your own doctor has ordered the transport and he or she will be treating you at a new location because of an illness or injury that requires immediate treatment.
- If someone else calls an ambulance for you and it’s determined that you’re having trouble breathing, have lost consciousness, or are unable to move because of extreme pain—all symptoms that could indicate a heart attack—you may be eligible for coverage under Part B.
- If the paramedics arrive at your home and provide care without transporting you anywhere (for example, if they treat an allergic reaction), then Medicare won’t cover those services since they wouldn’t meet the criteria for being medically necessary due to lack of transportation.*
Which type of care you get determines which plan will pay for your ambulance service.
If you need to go to the hospital, Medicare will cover your ambulance service. You can also get a bill from the ambulance company if you don’t need to go to the hospital.
However, if you are having a non-emergency transport and do not have private insurance or supplemental coverage that covers this service, it is unlikely that Medicare will pay for your transport. In these cases, you may be responsible for paying all of the costs associated with your non-emergency transportation by ambulance.
Conclusion
It’s important to know your Medicare coverage and how it relates to ambulance services. If you have a question about your benefits, contact the Medicare helpline at 01919-339689 or visit their website.
