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CENTERS for MEDICARE& MEDICAID SERVICESMedicare Coverageof Ambulance ServicesThis official government bookletexplains:When Medicare helps coverambulance servicesWhat you payWhat Medicare paysWhat to do if Medicare doesn’tcover your ambulance service

Table of contentsMedicare coverage of ambulance services 5Emergency ambulance transportation 5Air transportation 6Non-emergency ambulance transportation 6“Advance Beneficiary Notice of Noncoverage” (ABN) 7Voluntary ABN 8Paying for ambulance services 9What do I pay? 9What does Medicare pay? 9How do I know if Medicare didn’t pay for my ambulance service? 9Medicare rights & protections 11What can I do if Medicare doesn’t pay for an ambulance trip? 11What if Medicare still won’t pay? 12

4The information inthis booklet appliesto all people withOriginal Medicare.If you have a MedicareAdvantage Plan or otherMedicare health plan,you have the same basicbenefits, but the rulesvary by plan. Your costs,rights, protections, andchoices about where youcan get your care maybe different. For moreinformation, read yourplan materials or callyour plan.“Medicare Coverage of Ambulance Services” isn’t a legal document.Official Medicare Program legal guidance is contained in the relevantstatutes, regulations, and rulings.The information in this booklet describes the Medicare program at thetime this booklet was printed. Changes may occur after printing. VisitMedicare.gov, or call 1-800-MEDICARE (1‑800‑633‑4227) to get themost current information. TTY users can call 1-877-486-2048.

5Medicare coverage of ambulance servicesMedicare Part B (Medical Insurance) covers ambulance services toor from a hospital, critical access hospital (CAH), or a skilled nursingfacility (SNF). Medicare covers and helps pay for ambulance servicesonly when other transportation could endanger your health, like ifyou have a health condition that requires this type of transportation.In some cases, Medicare may also cover ambulance services if youhave End-Stage Renal Disease (ESRD) (permanent kidney failurerequiring dialysis or a kidney transplant), need dialysis, and needambulance transportation to or from a dialysis facility.Medicare will only cover ambulance services to the nearestappropriate medical facility that’s able to give you the care you need. Ifyou choose to be transported to a facility farther away, Medicare willonly pay what it costs to take you to the closest facility that can giveyou the care you need. If no local facilities are able to give you the careyou need, Medicare will pay for transportation to the nearest facilityoutside your local area that’s able to give you necessary care. If youchoose to be transported to a facility farther away, Medicare will onlypay what it costs to take you to the closest facility that can give you thecare you need and you will be responsible for the remaining cost.Emergency ambulance transportationYou can get emergency ambulance transportation when you’ve had asudden medical emergency, and your health is in serious danger becauseyou can’t be safely transported by other means, like by car or taxi.These are some examples of when Medicare might cover emergencyambulance transportation: You’re in shock, unconscious, or bleeding heavily. You need skilled medical treatment during transportation.Remember, these are only examples. Medicare coverage depends onthe seriousness of your medical condition and whether you could’vebeen safely transported by other means.

6Medicare coverage of ambulance servicesAir transportationMedicare may pay for emergency ambulance transportation in anairplane or helicopter if your health condition requires immediate andrapid ambulance transportation that ground transportation can’t provide,and one of these applies: Your pickup location can’t be easily reached by ground transportation. Long distances or other obstacles, like heavy traffic, could stop youfrom getting care quickly if you traveled by ground ambulance.Non-emergency ambulance transportationYou may be able to get non-emergency ambulance transportation if it’sneeded to treat or diagnose your health condition and the use of anyother transportation method could endanger your health.In some cases, Medicare may cover limited, medically necessary,non-emergency ambulance transportation if your doctor writes anorder stating that ambulance transportation is necessary due to yourmedical condition. Even if a situation isn’t an emergency, ambulancetransportation may be medically necessary to get you to a hospital orother covered health facility.Note: If you get scheduled, non-emergency ambulance transportationfor 3 or more round trips in a 10-day period or at least once a week for3 weeks or more from an ambulance company based in New Jersey,Pennsylvania, South Carolina, Maryland, Delaware, the District ofColumbia, North Carolina, Virginia, or West Virginia, you or yourambulance company may send a request for prior authorization toMedicare before your fourth round trip in a 30-day period. This wayyou and the company will know earlier in the process if Medicare islikely to cover your ambulance services. If your prior authorizationrequest isn’t approved and you continue getting these services,Medicare will deny the claim and the ambulance company may billyou for all charges. For more information, call 1-800-MEDICARE(1-800-633-4227). TTY users can call 1-877-486-2048.

Medicare coverage of ambulance services7“Advance Beneficiary Notice of Noncoverage” (ABN)When you get ambulance services in a non-emergency situation,the ambulance company considers whether Medicare may cover thetransportation. If the transportation would usually be covered, butthe ambulance company believes that Medicare may not pay for yourparticular ambulance service because it isn’t medically reasonableor necessary, it must give you an “Advance Beneficiary Notice ofNoncoverage” (ABN) to charge you for the service. An ABN is a noticethat a doctor, supplier, or provider gives you before providing an item orservice if they believe Medicare may not pay.ABNs have option boxes that allow you to choose whether you want theservice and explain your payment responsibility. If you choose the optionbox that shows that you want and will pay for the service, and you sign theABN, you’re responsible for paying if Medicare doesn’t pay. The ambulanceprovider or supplier may ask you to pay at the time of service.Example: Mr. Smith is a hospital inpatient and needs to travel to adifferent hospital for a procedure that can’t be done in the hospital wherehe was admitted. Mr. Smith requires ground ambulance transportationbecause of his medical conditions, but he asks to be transported byair ambulance. Medicare will cover the cost of the ground ambulancetransportation, but won’t coverair ambulance transportationbecause this level of service isn’tmedically reasonable or necessary.The ambulance companymust give Mr. Smith an ABNbefore transporting him by airambulance, or the ambulancecompany will be responsible forany costs over the amount thatwould’ve been paid for groundambulance transportation.

8Medicare coverage of ambulance servicesIf you’re in a situation that requires an ambulance company togive you an “Advance Beneficiary Notice of Noncoverage” (ABN)and you refuse to sign it, the ambulance company will decidewhether to take you by ambulance. If the ambulance companydecides to take you, even though you refused to sign the ABN, youmay still be responsible for paying the cost of the trip if Medicaredoesn’t pay. You won’t be asked to sign an ABN in an emergency.Voluntary ABNIf an ambulance company believes that Medicare won’t coveran ambulance service, it may give you a voluntary ABN as acourtesy. In this situation, the ambulance company isn’t requiredto give you an ABN to bill you for the service. If the ambulancecompany does give you a voluntary ABN, you aren’t required tochoose an option box or sign it. In this situation, the ambulancecompany expects that Medicare won’t pay for the service, andyou’ll be financially responsible if Medicare doesn’t pay.Example: Mrs. Lee falls in her front yard and her neighborcalls an ambulance. She isn’t in distress, but she can’t standup without having ankle pain. When the ambulance arrives,Mrs. Lee wants to go to the hospital, but she doesn’t have aserious medical emergency and her health won’t be in dangerif she goes to the emergency room another way (like a car ortaxi). Since Mrs. Lee could get to the hospital by another typeof transportation without a serious risk to her health, Medicarewon’t cover the ambulance transportation. In this situation, theambulance company isn’t required to give Mrs. Lee any formalnotice, but out of courtesy, they may give her an ABN, so thatshe knows she’ll be billed for this service.If Medicare doesn’t pay for your ambulance trip and you believeit should’ve been covered, you may appeal. You must get theservice and a claim for payment must be submitted to appealMedicare’s decision. See pages 11–12 for information.

9Paying for ambulance servicesWhat do I pay?If Medicare covers your ambulance trip, you pay 20% of theMedicare-approved amount, after you’ve met the yearly Part Bdeductible.In most cases, the ambulance company can’t charge you morethan 20% of the Medicare-approved amount and any unmetPart B deductible. All ambulance companies must accept theMedicare-approved amount as payment in full. In some cases, whatyou pay may be different if you’re transported by a critical accesshospital (CAH) or an entity that’s owned and operated by a CAH.What does Medicare pay?If Medicare covers your ambulance trip, Medicare will pay 80%of the Medicare-approved amount after you’ve met the yearlyPart B deductible. Medicare’s payment may be different if you’retransported by a CAH or an entity that’s owned and operated bya CAH.How do I know if Medicare didn’t pay for my ambulanceservice?You’ll get a “Medicare Summary Notice” (MSN) in the mail every3 months that lists all the services billed to Medicare. You canalso visit MyMedicare.gov to look at your Medicare claims or viewelectronic MSNs. Your MSN will tell you why Medicare didn’t payfor your ambulance trip.

10Paying for ambulance servicesExamples: If you chose to go to a facility farther than the closest one, yournotice may say this: “Payment for transportation is allowedonly to the closest facility that can provide the necessary care.” If you used an ambulance to move from one facility to anotherone closer to home, your notice may say this: “Transportationto a facility to be closer to a home or family is not covered.”Remember, these are only examples of statements you may see onyour MSN. Statements vary depending on your situation. If youhave questions about what Medicare paid, call the phone numberon your MSN or 1-800-MEDICARE (1-800-633-4227). TTY userscan call 1-877-486-2048.