Having a good understanding of what Medicare covers is crucial in determining which part of Medicare will fit your needs best. That’s why our team of licensed insurance experts is here to help you through this process and discuss your coverage options. A good example of understanding the coverage available is knowing if Medicare will provide coverage for ambulance transportation.
Ambulance services are covered under Medicare Part B. Your deductible and copayments will apply to the service. Medicare covers medically necessary trips to the nearest facility that can treat you. If the ambulance does not believe Medicare will pay, you will be given notice that you may end up with the bill.
Coverage for Emergencies
Medicare Part B will cover your ambulance ride to the hospital in the case of an emergency. They will cover the ride to the nearest facility that can treat you. If the nearest facility runs out of beds or is not equipped to help you, then Medicare may cover transport to the necessary location.
Are Non-Emergencies Covered?
For Medicare to cover non-emergency ambulance transportation, your physician must verify that an ambulance is necessary and you could not have traveled by any other method.
Coverage for Air Ambulances
Sometimes it is not possible or practical for a ground ambulance to reach you. In that case, an airplane or helicopter ambulance may be sent to your rescue, especially in remote locations. Medicare will still cover air ambulances under Part B, covering service to transport you to the nearest hospital or health care facility that can attend to your needs.
What Will be the Ambulance Cost?
Ambulance services are covered under Medicare Part B as a medically necessary service. As a Medicare Part B covered service, you will first have to meet the annual deductible and then will be charged 20% of the Medicare-approved amount for the covered service. The Medicare-approved amount for ambulance services varies based on a number of factors. These can include which state you are in, your situation, the billing code, the level of care you need in the ambulance, the mode of transportation (ground or air), and the distance you travel.
You don’t need to worry about excess charges for your ambulance ride. Part B excess charges are when a health care provider charges up to 15% higher than the Medicare-approved amount for covered services. Ambulance companies are not allowed to charge you this and have to accept Medicare’s price as payment.
If you have a Medicare Advantage plan, you may have lower copayments for your ambulance ride. This varies plan by plan.
Advance Beneficiary Notice of Noncoverage
Medicare may not always pay for covered services if they believe them not to be medically necessary. If the ambulance company thinks that Medicare may not pay for your ride, they will give you an Advance Beneficiary Notice of Noncoverage. That means you will have to pay the bill if Medicare does not, and you will be asked to sign the notice. At that point, you can choose not to take the ride. If you ride in the ambulance without signing, you can still be charged.
You may receive a Voluntary Advance Beneficiary Notice of Noncoverage, which the ambulance operator will give you if they are responding to a non-emergency. You do not have to sign this, but it still indicates the same: that they expect Medicare not to pay for the ambulance services and you could be stuck with the bill.
Still have questions about coverage for ambulance services? Reach out to the team at Malhotra and Assoc. Insurance.