Medicare coverage5 Important points about Medicare Part A and Part B coverage gaps
You hope you never need an ambulance to take you to the hospital, but it's good to know that Medicare may cover it in many situations.
Medicare Part B, which covers doctors' services, outpatient care, medical supplies and preventive services, has covered ambulance transports in certain situations since April 2002.1
Ambulance transports are covered if your condition prevents you from traveling any other way. Also, the transport must be medically reasonable and necessary and the destination must be nearby and appropriate. Your situation does not necessarily have to be an emergency.
Per Medicare.gov “Medicare Part B (Medical Insurance) covers ambulance services to or from a hospital, critical access hospital (CAH), or skilled nursing facility (SNF).”2
If you want to go to a facility that's farther away than the one closest to you, Medicare will cover only the cost of taking you to the closest appropriate facility. But if no facility in your area can give you the care you need, Medicare will pay for you to be taken to the nearest facility outside of your local area that can.
If you have a sudden, serious medical emergency, such as if you're in shock, unconscious or bleeding heavily or require skilled medical care on your way to the hospital, Medicare might cover an ambulance ride if you can't be safely transported by a car or taxi.2
If your condition is so serious that ground transportation isn't fast enough, Medicare might cover the cost of an air ambulance, either a plane or a helicopter. In addition, at least one of these must be true: Either you can't easily be reached by ground transportation, or long distances or heavy traffic could prevent you from getting care soon enough if you traveled by ground.2
In a non-emergency situation, Medicare might still cover an ambulance ride to a hospital or health facility, if your doctor writes an order saying that your medical condition makes it necessaryIf you have end-stage renal disease (ESRD), Medicare might cover ambulance transportation to or from a dialysis center. 2
If you have three or more scheduled roundtrips in an ambulance in a 10-day period or at least once a week for three weeks or more, you might be affected by a Medicare demonstration program. Under this program, Medicare might have to authorize in advance your fourth roundtrip in a 30-day period. If Medicare doesn't approve your request but you still go ahead and get that fourth roundtrip in a 30-day period, the ambulance company may bill you the entire cost.
Currently, the project involves ambulance companies in the District of Columbia and eight states: Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia, but it's supposed to be expanded to all states in 2017.3
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