DO YOU KNOW IF YOUR HEALTH INSURANCE HAS EMERGENCY TRANSPORTATION COVERAGE?

You don’t want to wait until a medical emergency to find out if your insurer provides emergency transportation coverage. Emergency transport may be needed when you have an urgent need for medical care and must reach a hospital quickly. You typically obtain emergency transportation by calling 9-1-1. Paramedics or EMTs would arrive at your door and provide you with immediate first aid, then transport you to a clinic or hospital. 

There are a few types of emergency transport:

• Basic Life-support ambulances
• Advanced life support ambulance
• Air ambulance

insurers and emergency transportation coverage

Medicare

Both Original Medicare (Medicare Part B) and Medicare Advantage (Medicare Part C)—provide emergency transportation coverage.

Medicare Part B will usually cover up to 80% of the Medicare-approved amount for a ground ambulance service after the patient has met the deductible. Air emergency-transportation is covered if ground-transport cannot provide rapid transportation to a hospital.

Eligibility criteria:

• Ambulance service is covered when transportation in any other vehicle would endanger the patient’s health

What Else Do I Need to Know?

• Find out if all the services are covered by Medicare
• Ambulance service will be covered only to the nearest appropriate medical facility that can provide the service that you need
• In the absence of a local facility that can provide the care you need, Medicare will cover transportation to the closest suitable facility outside your local area
• You will need an Advance Beneficiary Notice of Noncoverage from your ambulance company if:
  • The ambulance service was provided in a non-emergency situation
  • The ambulance company does not think Medicare will cover the specific service

Advance Beneficiary Notice of Noncoverage is a notice issued by your care service provider when a Medicare payment is expected to be denied.

Here is a useful resource on Medicare’s coverage of ambulance services.

Medicare Advantage

Medicare Advantage (MA) plans will provide the same basic coverage as Original Medicare through Medicare Part C, your share in the cost, what choices you have, etc. may vary based on the plan. Call your MA plan for specific details.

Medicaid

Medicaid covers emergency medical transportation for eligible individuals, with an emergency defined as immediate need for medical assistance. No pre-approval for emergency ground or air ambulance is required. 

Medicaid also has what is called an Assurance of Transportation. “Federal regulations require State Medicaid agencies to specify in the State plan that they will ensure necessary transportation for clients to and from providers and describe the methods that the agency will use to meet this requirement.” This includes minimum requirements for drivers that perform the transportation.

Private Insurance

Private insurance companies have their own guidance and regulations about coverage for ambulance services. It’s best to speak to your insurance company about their coverage policies for ambulance services. 

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Additional reading and resources

Looking for non-emergency medical transportation? This infographic can provide you with options and resources.

You can help Patients Rising better understand your transportation needs by filling out this quick survey.

Are you familiar with Patients Rising Concierge? It is an online, phone, and email support service that can assist you find local, state, and national resources, programs, and services.

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