One of the questions that I am frequently asked is whether or not Medicare pays for ambulance service. This usually happens when an ambulance is used to go from the nursing home to the doctor’s appointment for instance. The spouse or family gets a large bill from the ambulance company asking for payment. Mistakenly it was believed that Medicare would pay for this service.
Medicare Part B (Medical Insurance) will pay for the ambulance to or from a hospital, critical- access hospital, or skilled nursing facility only if other transportation would endanger your health.
In some cases, Medicare may pay for the ambulance from your home or medical facility to get health care for a condition that requires ambulance transportation. Medicare may also cover the ambulance to or from the dialysis facility if you have End-Stage Renal Disease, and need ambulance service because your health could be endangered by other transportation modes.
For example, if you are in a nursing home and need to go to dialysis twice a week, if you can go by gurney service, then Medicare will not pay for ambulance service.
Medicare will also pay for the ambulance in a medical emergency and time is critical. For example when you are in severe pain, bleeding, in shock, or unconscious. Also when you need skilled medical treatment during transportation.
Airplane or helicopter emergency ambulance may also be paid for by Medicare if your pick up location cannot easily be reached by ground transportation or things like heavy traffic or long distances prevent quick care. Payment will be based on the closest appropriate facility. If you seek services from a facility beyond that point, you will pay for the extra distance.
Non-emergency ambulance service may be covered by Medicare when you need ambulance service and any other mode of transportation could be dangerous to your health. It could also be provided if you have a letter from your doctor that ambulance service is necessary due to your medical condition.
In a non-emergency situation, the ambulance company must give you an Advance Beneficiary Notice (ABN) if they think that Medicare will not pay for their services. The ABN gives you options. One option is to check the box that you want the ambulance and will pay for it if Medicare doesn’t. The other option is to check the box that you don’t want the ambulance. If you don’t sign the form, the ambulance company decides whether or not to take you. You may still be responsible for payment if Medicare doesn’t pay.
If Medicare does pay for the ambulance, you will pay 20% of the Medicare-approved amount after meeting the Part B annual deductible of $147.00. Your payment may be different if you are taken to a critical access hospital. If Medicare doesn’t pay for an ambulance trip and you think they should have, you can appeal.
The Medicare Summary Notice that you get from Medicare will explain why they didn’t pay. It could be that the ambulance company didn’t completely document why you needed an ambulance or maybe they didn’t file the proper paperwork. If that doesn’t work, follow the instruction on the Medicare Summary Notice and keep copies of everything that is sent in. For further information, go to www.Medicare.gov or call 1-800- Medicare (1-800-633-4227).
Karl Kim, CFP, CLTC is the President of Retirement Planning Advisors, Inc. and is a Medi-Cal specialist. His office is located in La Mirada, CA and can be reached at 714-994-0599 or at RetirementCrisisPlanning.com