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Ambulance Services and Medicare Coverage

Ambulance services can get expensive but they can be necessary if you have a medical emergency. Don’t stress; Medicare will cover costs for certain situations.

Ambulance services

Ambulance services are typically used in an emergency. Emergency ambulance transportation to a hospital or skilled nursing facility is there for when a sudden medical emergency takes place and another form of transportation is not an option for safety purposes.

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Medicare coverage

Medicare Part B will usually cover the costs of emergency ambulance transportation as long as the reasoning for using the service meets the following criteria:

  • Other forms of transportation would endanger your health.
  • You need medically necessary care from a hospital or skilled nursing facility.

It is also important that you meet the requirements for what is considered an emergency. According to the Centers for Medicare & Medicaid Services (CMS), it is considered an emergency if someone is in shock or experiencing uncontrollable bleeding. Generally, emergency ambulance services are covered when the condition requires immediate medical care during transportation.

Medicare typically covers 80 percent of the Medicare-approved amount for the ambulance service. You will be responsible for the remaining 20 percent. The Medicare Part B deductible applies as well.

Other options

You can still use ambulance services even if it does not qualify as an emergency. Medicare coverage will likely deny coverage, though. If that is the case, the ambulance provider will be required to issue you an Advance Beneficiary Notice (ABN) in order to notify you of your financial responsibility for the transportation.

Once you have filled out the form for the ambulance service, you will be responsible for paying for the service if Medicare makes the decision to not cover the service. The ambulance provider may even ask for payment at the time of service, so it is important to ask before using the transportation in a non-emergency situation.

Make sure that you know what is covered under your Medicare coverage to avoid potential charges.

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