For Members

Does Medicare Cover Ambulance Rides and ER Visits?

Yes, with rules. Here is when Medicare pays for an ambulance, what an emergency room visit costs you, and what to do about a bill you didn't expect.

The short answer: yes. Medicare Part B covers a ground ambulance ride when riding in any other vehicle could put your health in danger. The ride must take you to a hospital, critical access hospital, rural emergency hospital, or skilled nursing facility for care you need. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. Part B also usually covers emergency room visits. You pay a copay for each visit and for each hospital service. After the deductible, you also pay 20% of the approved amount for the doctor's care. Medicare Advantage plans must cover everything Original Medicare covers. Your copays are set by the plan.

When Medicare covers an ambulance ride

Medicare pays for an ambulance when it is medically necessary. That means two things must be true:

Medicare only pays for a ride to the nearest appropriate facility that can give you the care you need. If you ask to go to a hospital farther away, you may owe the extra cost.

Medicare may also pay for an emergency ride in an airplane or helicopter. That only applies when you need immediate, rapid transport that a ground ambulance can't provide.

Non-emergency ambulance trips need a doctor's order

Sometimes a person needs an ambulance for a scheduled trip, not an emergency. One example is a person with kidney failure who can't safely get to dialysis any other way. Medicare may pay for this kind of trip. But you need a written order from your doctor or other provider saying the ambulance is medically necessary.

Watch for a form called an Advance Beneficiary Notice of Noncoverage (ABN). The ambulance company must give you one when the trip is not an emergency and the company believes Medicare may not pay. Signing it means you agree to pay if Medicare says no.

Some people take scheduled, non-emergency ambulance trips often. That means 3 or more round trips in 10 days, or at least once a week for 3 weeks or more. If that's you, a Medicare demonstration program may apply. Your ambulance company can ask Medicare for prior authorization before your fourth round trip in a 30-day period. If the request isn't approved and you keep taking the trips, Medicare will deny the claim. The company may then bill you for all charges.

If you just need a ride to a regular appointment, an ambulance is not the answer. Medicaid and some Medicare Advantage plans offer non-emergency medical transportation instead.

What you pay for an emergency room visit

Emergency department services are the care you get in a hospital ER for an injury, a sudden illness, or an illness that quickly gets much worse. Under Original Medicare:

Being admitted matters for more than the copay. A night in the hospital under "observation" is still outpatient care billed to Part B. See observation status vs. inpatient admission for why that can cost you later.

Urgent care is different from the ER. It treats a sudden illness or injury that isn't life-threatening. Part B covers it, and you pay 20% of the approved amount after the deductible.

Medicare Advantage and emergency care

If you're in a Medicare Advantage plan, the plan must cover all medically necessary services that Original Medicare covers. Plans can require you to use network doctors and hospitals for non-emergency care. Your ER and ambulance copays are set by the plan. Check your Evidence of Coverage booklet or call member services. Plans also have a yearly limit on what you pay out of pocket for covered services. Our Medicare Advantage guide covers the trade-offs.

Surprise bills and ground ambulances

You may have heard of the No Surprises Act. It protects people with employer or Marketplace insurance from surprise out-of-network bills. It covers ER visits and air ambulance rides. But ground ambulance rides are not covered by that law. Ground ambulance companies can still bill out-of-network rates. Your state may have its own rule.

Medicare and Medicaid already have their own protections against some unexpected out-of-network bills. If you get a bill that seems wrong, don't just pay it. Compare it to your Medicare Summary Notice or plan statement, and read about your rights.

If Medicare denies the claim

You can file an appeal if Medicare or your plan refuses to pay for a service you already got. Ask the ambulance company or hospital for records that show why the trip or visit was necessary. Then follow the appeal steps in How Do I Appeal a Denied Claim. Your State Health Insurance Assistance Program (SHIP) gives free, personal help with appeals.

Common questions

Will Medicare pay for an ambulance to my doctor's office?

Generally no. Medicare covers ambulance rides to a hospital, critical access hospital, rural emergency hospital, or skilled nursing facility, and only when other transport could endanger your health. For routine appointments, ask your plan about non-emergency transportation.

What if the ambulance took me to a hospital that's farther away?

Medicare pays for a ride to the nearest appropriate facility that can treat you. If a closer hospital couldn't give you the care you needed, the longer trip can still be covered. If you chose a farther hospital by preference, you may owe the difference.

Does Medicare cover an ER visit outside the United States?

Only in rare situations. See Does Medicare cover you when you travel? for the exceptions and what a Medigap policy may add.

I signed an ABN before a non-emergency ride. Do I have to pay?

An ABN means the ambulance company expects Medicare may not pay, and you agreed to pay if that happens. The claim still goes to Medicare first. If Medicare denies it, you can appeal, especially if your doctor's written order shows the trip was medically necessary.

Related pages

Official sources: Medicare.gov: Ambulance services, Medicare.gov: Emergency department services, and CMS: Know your rights with insurance.

Verify at the source. The coverage rules and cost-sharing above are Medicare's published rules as of this writing. Your plan materials and your Medicare Summary Notice control your specific case. Confirm details at Medicare.gov or call 1-800-MEDICARE, and get free help from your SHIP.