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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that Medicare pays for air ambulance services only if the enrollee's medical condition is such that transportation by either basic, the provision of medically necessary supplies and services or advanced life support, an emergency medical technician (EMT) intermediate or EMT-Paramedic ground ambulance is not appropriate. Air ambulance services may be covered only if: 
 
1. certain vehicle and crew requirements are met; 
 
2. the enrollee's medical condition needed immediate and rapid ambulance transport that could not have been provided by ground ambulance; and  
 
3. either the point of pickup is not accessible by ground vehicle or great distances or other obstacles are involved in getting the patient to the nearest hospital with appropriate facilities. 
 
You can find this rule in the Medicare Benefit Policy Manual, Chapter 10, Sections 10.4, and 10.4.1, and 30.1.1. 
 
Air ambulance transport is covered for transfer of a patient from one hospital to another if the medical appropriateness criteria are met, that is, transportation by ground ambulance would endanger the beneficiary's health and the transferring hospital does not have adequate facilities to provide the medical services needed by the patient. Examples of such specialized medical services that are generally not available at all type of facilities may include but are not limited to: burn care, cardiac care, trauma care, and critical care. A patient transported from one hospital to another hospital is covered only if the hospital to which the patient is transferred is the nearest one with appropriate facilities. Coverage is not available for transport from a hospital capable of treating the patient because the patient and/or the patient's family prefer a specific hospital or physician. You can find this information in Medicare Benefit Policy Manual Chapter 10 - Ambulance Services, 10.4.4 - Air Ambulance Services, Hospital to Hospital Transport.  
 
Transportation of a beneficiary from his or her home, an accident scene, or any other point of origin is covered under Part B as an ambulance service only to the nearest hospital, critical access hospital (CAH), or skilled nursing facility (SNF) that is capable of furnishing the required level and type of care for the beneficiary's illness or injury and only if medical necessity and other program coverage criteria are met. You can find this information in Medicare Benefit Policy Manual Chapter 10 - Ambulance Services, 10.3.3 Ground Ambulance. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules. The Plan contract also says that covered ambulance services include fixed wing services to the nearest appropriate facility that can provide care. You can find this information on page 65 of the Plan's 2020 Evidence of Coverage. The Plan contract also says Travel Assurance is available for members while traveling. This kit contains information on how to access urgent and emergent healthcare for services while traveling. You can find this information on page 73 of the Plan's 2020 Evidence of Coverage.