Will Medicare cover emergency ambulance rides?

Dear Savvy Senior: A few months ago, I took an ambulance to the hospital emergency room because I had a nasty fall at home. I just received a hefty $1,050 bill from the ambulance company. Doesn’t Medicare cover ambulance rides? — Frustrated Beneficiary

Dear Frustrated Beneficiary: Yes, Medicare does cover emergency ambulance services and, in limited cases, nonemergency ambulance services, but only when they’re deemed medically necessary and reasonable.

So, what does that mean?

First, it means that your medical condition must be serious enough that you need an ambulance to transport you safely to a hospital or other facility where you can receive care that Medicare covers.

If a car or taxi could transport you without endangering your health, Medicare won’t pay. For example, Medicare probably won’t pay for an ambulance to take someone with an arm fracture to a hospital. But if the patient goes into shock or is prone to internal bleeding, ambulance transport may be medically necessary to ensure their safety on the way. The details make a difference.

Second, the ambulance must take you to the nearest appropriate medical facility. If you choose to be transported to a facility farther away because the doctor you prefer has staff privileges there, expect to pay a greater share of the bill. Medicare will only cover the cost of ambulance transport to the nearest appropriate facility and no more.

Medicare may also pay for an emergency flight by plane or helicopter to the nearest appropriate medical center if the trip would take too long on the ground and endanger your health.

Nonemergency situations

Medicare may also cover ambulance transportation in some cases when you’re not facing a medical emergency. But to receive this coverage, your doctor needs to write an order stating that an ambulance is medically necessary because other ways to get you to an appointment could endanger your health.

For example, if you’ve been diagnosed with end-stage renal disease, Medicare may pay if you have a doctor’s order stating that it is medically necessary for you to use an ambulance to take you to and from a dialysis center.

You also need to know that in nonemergency situations, ambulance companies are required to give you an advance beneficiary notice of noncoverage, or ABN, if they believe Medicare may not pay. This lets you know that you will be responsible for paying if Medicare doesn’t.

Ambulance costs

Ambulance rides can vary from several hundred to several thousand dollars depending on where you live and how far you’re transported.

Part B pays 80 percent of the Medicare-approved ambulance rides after you’ve met your annual deductible ($257 in 2025). You, or your Medicare supplemental policy (if you have one), are responsible for the remaining 20 percent.

If you have a Medicare Advantage Plan, it must cover the same services as original Medicare and may offer some additional transportation services. You’ll need to check with your plan for details.

How to appeal

If an ambulance company bills you for services after Medicare denies payment, but you think the ride was medically necessary, you can appeal at Medicare.gov. To help your case, ask the doctor who treated you for documentation that you needed an ambulance.

Your State Health Insurance Assistance Program can help you file an appeal. Go to ShipHelp.org for contact information.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org.