Ambulance services are covered by Medicare Part B. If you need to be airlifted to the hospital or transported from one hospital to another that has superior services in a medical emergency, it may be covered. Medicare covers transport to hospitals, critical access hospitals, and skilled nursing facilities for medically necessary services when transport in any other vehicle would be a danger to your health. When ground transport cannot provide immediate support, Medicare will cover emergency ambulance transportation in an airplane or helicopter if immediate, rapid ambulance transportation is necessary.
For ambulance services, you will owe 20 percent of the Medicare-approved amount and the Part B deductible applies.
Medicare covers transport to the nearest facility that can offer the medical support you need. If the ambulance company believes Medicare will not pay for your transport or it was used for a non-emergency, they will let you know by giving you an Advance Beneficiary Notice of Noncoverage.
Medicare does not cover transportation to visit your doctor. Some non-emergency transport may be covered if deemed medically necessary with a written order by your doctor. This may be the case for people receiving dialysis treatment.
If you receive scheduled non-emergency rides from an ambulance company, you must receive prior authorization from Medicare to receive coverage. These trips are for those that receive transport for 3 round trips in a 10-day period or once a week for three weeks or more. This applies if your ambulance company is based in New Jersey, Pennsylvania, South Carolina, Maryland, Delaware, District of Columbia, North Carolina, Virginia, or West Virginia. The company will need to send a request for prior authorization before the fourth round trip in a 30 day period. If you do not get prior authorization, Medicare will deny your claim and you will have to pay for the services.
While Medicare may not cover all of your transport needs, there are agencies or other plans that could be the answer for you. Local organizations such as your Area Agency on Aging (AAA) may be able to connect you with local services for transport to and from doctor visits. Medicaid and the Program of All-Inclusive Care for the Elderly (PACE) also have reliable transportation options available for members.
Additionally, Medicare Advantage plans are allowed to offer innovation benefits, which can include transportation to and from medical appointments. Medicare Advantage plans are Part C, private health care plans that you can choose once you are enrolled in Part A and Part B.
To learn more about what Medicare Part B and other Medicare plans cover regarding medical transportation, reach out to an agent with Bobby Brock Insurance.