- It is medically necessary. Meaning that an ambulance is the only safe way to transport you and the reason for your trip is to receive a service or to return from a service that you need and Medicare will cover;
- you are transported to and from certain locations; and
- the supplier meets Medicare ambulance requirements.
An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse.
If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered an emergency. If it is not an emergency, Medicare coverage of ambulance services is very limited.
Medicare may cover non-emergency ambulance services if:
- You are confined to your bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair); or
- you need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions..
Medicare may cover scheduled, regular trips if your doctor sends the ambulance supplier a written order ahead of time to show that your health requires ambulance transport. For unscheduled, or irregular non-emergency trips, a doctor’s order may be required within 48 hours after the transport if you live in a SNF.
Note: If you are receiving SNF care under Part A, any ambulance transport should be paid for by the SNF. The SNF should not bill Medicare for this service.
Note: Lack of access to alternative transportation alone will not justify Medicare coverage. Medicare will never pay for ambulette services. An ambulette is a wheelchair-accessible van that provides non-emergency transportation for people with disabilities.
If covered, Medicare will pay for 80% of its approved amount for the ambulance service. You or your supplemental insurance policy will be responsible for the remaining 20%. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full.