Ambulance Services and Medicare: How to Ensure Coverage

Ambulance Services and Medicare: How to Ensure Coverage

Part B of Medicare includes coverage for both emergency and non-emergency ambulance services deemed medically necessary, reimbursing 80% of the Medicare-approved amount.

Typically, after meeting your Part B deductible (which is $240 in 2024), you are responsible for a 20% coinsurance.

It’s important to note that all ambulance companies working with Medicare must be participating providers.

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What is Medicare?

Medicare, established in 1965, is a health insurance program primarily for Americans aged 65 and older, serving as a vital resource for meeting their healthcare needs after retirement.

  • Certain individuals with disabilities
  • Patients with End-Stage Renal Disease (ESRD), which necessitates dialysis or a kidney transplant

Medicare comprises both government-provided plans and those offered by private insurers, with various plan types covering different aspects of healthcare.

How does Medicare coverage work?

It’s important to clarify that Medicare does not operate its air ambulances for patient transport, but it may cover the costs of booking one.

Let’s explore the Medicare plans that could potentially cover air ambulance services.

Medicare is divided into four parts, labeled alphabetically from Part A to Part D:

An infographic of how Medicare works: photo courtesy
  • Part A (Hospital Insurance): Covers hospice care, skilled nursing facility care, inpatient hospital stays, and some home health care.
  • Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and medical supplies.
  • Part C (Medicare Advantage): Involves enrollment in a private insurance plan that provides Medicare benefits.
  • Part D (Prescription Drug Coverage): Helps with the cost of prescription drugs, including recommended vaccines.

For this discussion, let’s focus on the details of Part B coverage.

How does Medicare Plan B work?

Part B is a component of Original Medicare, where beneficiaries pay for services as they’re received.

This means they pay an annual deductible and typically 20% of the Medicare-approved service cost as coinsurance.

Beneficiaries also have the option to add a separate drug plan (Part D) for medication coverage.

Original Medicare covers a significant portion of healthcare service and supply costs, but not all.

To help cover the remaining expenses like deductibles, coinsurance, and copayments, Medicare Supplement Insurance (Medigap) can be beneficial.

Some Medigap policies even cover services not included in Original Medicare, such as emergency medical care while traveling abroad for medical reasons.

Additionally, when enrolling in Medicare, another option is Medicare Advantage, which is a Medicare-approved private company plan that typically includes Parts A, B, and D.

These plans may offer additional benefits like vision, hearing, and dental care, which Original Medicare doesn’t cover.

It’s important to note that each Medicare Advantage Plan has its own rules and costs for services.

Does Medicare cover air ambulances?

Medicare might pay for your air ambulance if your doctor says it’s needed right away and a ground ambulance can’t reach you.

However, Medicare prefers using cheaper land ambulances.

If you need to be airlifted to a hospital for serious surgery and your current hospital can’t do it, Medicare will likely cover the air ambulance costs.

However, if there’s no immediate danger, Medicare probably won’t cover it.

For Medicare to cover your air ambulance, either a ground ambulance can’t get to you, or there’s a long distance to travel by ground, or obstacles like heavy traffic could delay reaching the nearest hospital.

In rural areas, you automatically meet Medicare’s criteria if a doctor decides air transport is necessary because of time or distance, and the air ambulance meets Medicare’s rules.

What if Medicare does not cover your medical flight?

Medical Air Service offers a variety of aeromedical services. We handle medical repatriation, where we transport you from your current hospital to a medical facility in your home country.

We also provide medical evacuation to the nearest hospital or clinic if the care at your current location is inadequate.

Additionally, we offer a medical escort service if you’re able to travel on a commercial flight, along with ground ambulances to transfer you between the hospital and the plane.

It’s important to note that Medical Air Service will transport you regardless of whether Medicare covers the air ambulance.

There are several ways to save money when traveling abroad for medical care. If your health allows, you can take a scheduled flight and use one of our medical escorts.

Supplementing your Medicare plan with private insurance, as well as obtaining travel insurance, can also help reduce costs.

Crowdfunding is another option to consider as a last resort, as people online can be very generous.

Is ambulance free in Australia?

Queensland and Tasmania offer their residents free ambulance services.

However, residents in other Australian states and territories are required to pay for ambulance trips unless they have ambulance coverage through their private health insurance or have purchased an annual ambulance subscription.

What to do if your ambulance claim is rejected

The initial step involves reviewing your Medicare Summary Notice (MSN) to understand why the claim for ambulance services was denied.

Often, the denial is due to a mistake or incomplete information provided, which prevents Medicare from assessing the validity of the ambulance cost.

Contact the hospital, health center, or physician who provided your care.

Request thorough information and ensure all necessary details are provided before resubmitting the claim.

It’s possible that the ambulance service has not yet filed the paperwork or there may have been an error in the submission.

Communicate with them to address any discrepancies and request them to resubmit the claim accordingly.

If your claim for ambulance services remains denied, you may consider initiating an appeal.

Nonprofit organizations like Medicare Advocacy frequently highlight instances where Medicare coverage for ambulance transportation is wrongly denied.

If your transportation meets the coverage guidelines but is denied Medicare coverage, filing an appeal is recommended.

What you’ll pay for ambulance transportation

If you are solely covered by Original Medicare, you are responsible for paying 20% of the Medicare-approved amount for ambulance services, and the Medicare Part B deductible, which is $240 in 2024, applies.

An image of Is ambulance covered by Medicare: photo courtesy/freepik

 

Medicare’s coverage for ambulance transportation is limited to the nearest medical facility that can provide the necessary care.

With Medicare Supplement Insurance, also known as Medigap, your 20% share is typically covered by the plan.

However, if you request transportation to a treatment facility that is not the nearest one, Medicare Part B and Medigap will only cover the cost to the closest location.

In such cases, you would incur additional out-of-pocket expenses to cover the difference.

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