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Health emergencies are a part of life sometimes and an emergency room is often the right place for the testing and care we need. Statistically, seniors use the ER at higher rates than most other age groups.
Top reasons seniors visit the emergency room:
Broken bones
Trouble breathing
Chest pain
Heart attack
Sudden slurred speech
Severe dizziness or disorientation
Severe allergic reaction
Unconscious/unresponsive
Signs of infection
Broken bones
When we are unable to transport ourselves or the situation requires particularly urgent attention, we may call an ambulance to transport us to the hospital. We all know health services are not free, even when we have Medicare. So, the question is does Medicare pay for ambulance charges?
Does Medicare Pay for Ambulance Charges?
Medicare Part B (medical insurance) covers a percentage of the cost of both public and private ambulance transportation to a health care facility under the following conditions:
The ride is medically necessary or is approved by a physician for other reasons
Transportation is provided to the nearest medical facility that can give you the care you need
Transportation in any other vehicle would be a risk to your health
Obviously, it is not always easy to know what qualifies as a medically necessary reason for an ambulance ride so there will always be a chance that the service won’t be covered.
Ambulance transportation coverage in an emergency
If you believe that yourself or a loved one is experiencing a medical emergency that requires ambulance transportation then you should call for an ambulance. After the health issue is handled, you can then follow up with healthcare providers to make sure they support your claim by documenting that the health issue was an emergency. If necessary, make your case to them that based on the symptoms you were experiencing or witnessing at the time that it was reasonable to believe that it was an emergency in need of ambulance transportation.
Ambulance transportation coverage in a non-emergency
If a physician certifies that ambulance transportation was necessary in a non-emergency situation, then Medicare may cover the service. Requirements may include:
The patient must be confined to a bed
The patient required important medical care during the trip
The ambulance must take the patient directly to a healthcare facility that offers Medicare-covered services
If your non-emergency ambulance trip is handled by a private company such as AMR Hawaii, they are obligated to give you an Advance Beneficiary Notice of Noncoverage if they believe that the transportation may not be covered by Medicare.
What do Medicare recipients pay out-of-pocket for ambulance transportation?
The out-of-pocket costs for an ambulance ride can range from a few hundred dollars to $1,000 or more. Medicare pays 80% of the cost of approved ambulance transportation services. Medicare recipients pay the other 20% plus any remaining Medicare Part B deductible for the calendar year.
Do Medicare Advantage plans cover ambulance charges?
Medicare Advantage must provide at least the coverage that Medicare Part B provides, which means that Medicare Advantage Plan members do receive ambulance coverage. Medicare Advantage Plans in Hawaii may offer additional ambulance coverage; speak to your Medicare agent about your coverage options.
What can I do if my ambulance claim is denied?
If your ambulance claim is denied, you do have recourse. If you believe that your ambulance ride met Medicare’s requirements but it was denied, you can file an appeal. Talk to your Medicare agent for help.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.