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CENTERS FOR MEDICARE & MEDICAID SERVICES
 

Medicare Coverage 

of Ambulance Services 

This official government 

booklet explains 

when Medicare helps cover 

ambulance services. 

what Medicare pays. 

what you pay. 

what to do if Medicare 

doesn’t cover your 

ambulance service. 
Table of Contents
 

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
 

Medicare Coverage of Ambulance Services 

Emergency ambulance transportation . . . . . . . . . . . . . . . . . . . 2
 

Nonemergency ambulance transportation . . . . . . . . . . . . . . . . 3
 

What does Medicare pay? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
 

What do I pay? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
 

How do I know if Medicare didn’t pay for my
 

ambulance service? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
 

Medicare Rights and Protections 

What can I do if Medicare doesn’t pay for an ambulance 


trip I think should be covered? . . . . . . . . . . . . . . . . . . . . . . 5
 

What if Medicare still won’t pay? . . . . . . . . . . . . . . . . . . . . . . . 6
 

Getting More Information . . . . . . . . . . . . . . . . . . . . . 7
 

Words to Know (Where words in brown are defined) . . . . 8–9 

Important: The information in this booklet was correct when it was 

printed. Changes may occur after printing. For the most up-to-date 

version, visit www.medicare.gov on the web. Select “Search Tools” and 

then select “Find a Medicare Publication.” Or, call 1-800-MEDICARE 

(1-800-633-4227). A customer service representative can tell you if the 

information has been updated. TTY users should call 1-877-486-2048. 

The “Medicare Coverage of Ambulance Services” booklet isn’t a legal 

document. The official Medicare Program provisions are contained in 

the relevant laws, regulations, and rulings. 
Words in 

brown are 

defined 

on pages 

8–9. 

Introduction
 

The information in this booklet is for people who are in the 

Original Medicare Plan. 

This booklet explains Medicare’s coverage of ambulance services in the 

Original Medicare Plan. The Original Medicare Plan is a 

“fee-for-service” plan. This means you are usually charged a fee for each 

health care service or supply you get. This plan, managed by the Federal 

Government, is available nationwide. If you are in the Original Medicare 

Plan, you use your red, white, and blue Medicare card when you get 

health care. 

If you are not in the Original Medicare Plan, read your plan 

materials for information about ambulance coverage. 

If you are in a Medicare Advantage Plan (like an HMO) or other 

Medicare plan, you may have different rules, but your plan must give 

you at least the same coverage as the Original Medicare Plan. Your costs, 

rights, protections, and/or choices of where you get your care may be 

different if you are in one of these plans. You may also get extra benefits. 

Read your plan materials or call your benefits administrator for more 

information. 

It’s important to know what health care services Medicare helps to cover. 

You get all your regular Medicare covered services under Medicare Part A 

and Part B. To learn more about Medicare, look at your copy of the 

“Medicare & You” handbook, which is mailed each fall to people with 

Medicare. You can order a copy by calling 1-800-MEDICARE 

(1-800-633-4227). TTY users should call 1-877-486-2048. You can also 

read or print a copy of this handbook at www.medicare.gov on the web. 

Select “Search Tools” and then select “Find a Medicare Publication.” 

1 
Medicare Coverage of Ambulance Services
 

Medicare Part B covers ambulance services to or from a hospital or 

skilled nursing facility only when other transportation would be 

dangerous to your health. In addition, you can be transported from 

your home or sometimes from a medical facility to get care for a health 

condition that requires you to be transported only by ambulance. 

Emergency ambulance transportation 

Emergency ambulance transportation is provided after you have had a 

sudden medical emergency, when your health is in serious danger, and 

when every second counts to prevent your health from getting worse. 

Some examples of when emergency ambulance transportation may be 

covered include when you 

• are in severe pain, bleeding, in shock, or unconscious, 

• need to be restrained to keep you from hurting yourself or others, or 

• need oxygen or other skilled medical treatment during transportation. 

These are only examples of when Medicare would cover your 

ambulance trip. Coverage would depend on the seriousness of your 

medical condition and whether you could have been safely transported 

by other means. 

Medicare will only cover ambulance services to the nearest appropriate 

medical facility that is able to give you the care you need. If you choose 

to be transported to a facility farther away, Medicare’s payment will be 

based on the charge to the closest facility. If no local facilities are able to 

give you the care you need, Medicare will help pay for transportation to 

a facility outside of your local area. 

Air Transportation

Medicare will pay for emergency ambulance transportation in an airplane 

or helicopter if your health condition requires immediate and rapid 

ambulance transportation that ground transportation can’t provide. 

2 
Words in 

brown are 

defined 

on pages	 

8–9. 

Medicare Coverage of Ambulance Services
 

Nonemergency ambulance transportation 

Nonemergency ambulance transportation is provided when you need 

transportation to diagnose or treat your health condition and you can’t be 

transported another way. You must have orders from your doctor or other 

health care provider for Medicare to cover nonemergency ambulance 

transportation. 

In some cases, Medicare covers limited nonemergency ambulance 

transportation if you are confined to your bed and you have a statement 

from your doctor saying that ambulance transportation is necessary 

because of your medical condition. Even if you aren’t confined to your 

bed, in some cases, Medicare may still cover your nonemergency 

ambulance trip if you have a statement from your doctor. 

If the ambulance company believes that Medicare won’t pay for your 

nonemergency ambulance service, they might ask you to sign an Advance 

Beneficiary Notice (ABN). You will be asked to choose an option by 

marking a box and signing the ABN. If you sign the ABN, you are 

responsible for paying the cost of the trip if Medicare doesn’t pay. 

If you refuse to sign the ABN, the ambulance company can decide 

whether or not to take you by ambulance. If the ambulance company 

decides to take you after your refusal to sign, you may be responsible for 

paying the cost of the trip if Medicare doesn’t. However, if Medicare 

doesn’t pay for the ambulance trip and you believe it should have been 

covered, you may submit an appeal. You must receive the service in order 

to appeal Medicare’s payment decision. 

You won’t be asked to sign an ABN in an emergency situation (see page 2). 

3 

See pages 

5–6 on 

appeal 

rights. 
Medicare Coverage of Ambulance Services
 

What does Medicare pay? 

If Medicare covers your ambulance trip, Medicare will pay 80% of the 

Medicare-approved amount after you have met the yearly Part B deductible 

($131 in 2007). Medicare’s payment may be different if you get services from 

a hospital-based ambulance company. 

What do I pay? 

If Medicare covers your ambulance trip, you pay 20% of the 

Medicare-approved amount, after you have met the yearly Part B deductible 

($131 in 2007). 

In most cases, the ambulance company can’t charge you more than 20% of the 

Medicare-approved amount. What you pay may be different however, if you 

get services from a hospital-based company. All ambulance companies must 

accept the Medicare-approved amount as payment in full. 

How do I know if Medicare didn’t pay for my 

ambulance service? 

You will get a Medicare Summary Notice (MSN), from the Medicare 

Administrative Contractor (MAC)* (the company that handles bills for Medicare). 

The notice will tell you why Medicare didn’t pay for your ambulance trip. 

For instance, if you chose to go to a facility further than the closest one, you 

would get this statement on your notice: 

“Payment for ambulance transportation is allowed only to the 

closest appropriate facility that can provide the care you need.” 

Or, if you used an ambulance to move from one facility to one closer to home, 

your notice would say: 

“Transportation to a facility to be closer to your home or family 

isn’t covered.” 

These are only examples of statements you may see on your notice. 

Statements vary depending on your situation. 

Call 1-800-MEDICARE (1-800-633-4227), if you have questions about what 

Medicare paid. TTY users should call 1-877-486-2048. 

4 *	 Medicare Administrative Contractors will gradually take over all Medicare Part A and 

Part B billing. In some areas of the country, Fiscal Intermediaries may still process 

Medicare Part A bills and Carriers may still process Part B bills. 
Words in 

brown are 

defined 

on pages 

8–9. 

Medicare Rights and Protections 

What can I do if Medicare doesn’t pay for an 

ambulance trip I think should be covered? 

You or someone you trust should carefully review your MSN and any 

other paperwork about your ambulance bill. You may find paperwork 

problems that can be fixed. You can also call your Medicare 

Administrative Contractor (MAC), the company that pays Medicare 

Part B bills, to get a more detailed explanation of why Medicare 

denied payment. 

While reviewing your MSN and other paperwork, you may find that 

Medicare denied your claim because: 

1) The ambulance company didn’t fully document why you needed 

ambulance transportation. 

If this happens, contact the doctor who treated you or the discharge 

social worker at the hospital to get more information about your 

need for transportation. You can send this information to the MAC. 

2) The ambulance company didn’t file the proper paperwork. 

If this happens, you can ask the ambulance company to refile your 

claim form. Don’t pay the bill until the ambulance company has 

done this. If the ambulance company won’t refile your claim, 

contact your MAC. Your MAC will contact the ambulance 

company on your behalf to make them aware of their responsibility 

for filing a Medicare claim. If refiling your claim doesn’t result in 

payment, you may file an appeal. 

5 
Words in 

brown are 

defined 

on pages 

8–9. 

Medicare Rights and Protections
 

What if Medicare still won’t pay? 

If you have Medicare, you have certain guaranteed rights to help protect 

you. One of these rights is the right to a fair, efficient, and timely process 

for appealing decisions about health care payment or services. 

If Medicare doesn’t cover your ambulance trip, you have a right to 

appeal. An appeal is a special kind of complaint you make if you 

disagree with decisions made by Medicare. To file an appeal, carefully 

review your MSN. It will tell you why your bill wasn’t paid, how long 

you have to file an appeal, and what appeal steps you can take. If you 

decide to file an appeal, ask your doctor or provider for any information 

that might help your case. You should keep a copy of everything you 

send to Medicare as part of your appeal. If you need help filing an appeal, 

call 1-800-MEDICARE (1-800-633-4227) to get the number for the 

State Health Insurance Assistance Program in your state. 

For more detailed information about appeals and other Medicare rights 

and protections, visit www.medicare.gov to read or print the booklet 

“Your Medicare Rights and Protections.” You can also call 

1-800-MEDICARE (1-800-633-4227) to find out if this booklet is 

available in print. 

6 
Getting More Information 

For information about Medicare and 

related topics 

Call 1-800-MEDICARE (1-800-633-4227) 

for answers and information 24 hours a day, every day. 

OR 

Visit www.medicare.gov on the web. 

Medicare Publications 

Medicare has information to help you make good health care decisions. 

You can view Medicare booklets to learn more about the topics that are 

of interest to you. We are always adding new booklets with detailed 

information about important subjects. 

How do I get these booklets? 

1. Visit www.medicare.gov on the web. Select “Search Tools” and then 

select “Find a Medicare Publication.” You can read or print these 

booklets. This is the fastest way to get a copy. 

2. Call 1-800-MEDICARE (1-800-633-4227), and select option “4” 

to find out if a booklet is available in print. TTY users should call 

1-877-486-2048. 

Some booklets are available in English, Spanish, Audiotape (English and 

Spanish), Braille, and Large Print (English and Spanish). 

Note: Some booklets may not be available in print, but all will be 

available at www.medicare.gov on the web. 

7 
Words to Know
 

Advance Beneficiary Notice 

(ABN)—A notice that a doctor or 

supplier should give a Medicare 

beneficiary when furnishing an item or 

service for which Medicare may deny 

payment. 

If you do not get an ABN before you 

get the service from your doctor or 

supplier, and Medicare does not pay for 

it, then you may not have to pay for it. 

If the doctor or supplier does give you 

an ABN that you sign before you get the 

service, and Medicare does not pay for 

it, then you will have to pay your doctor 

or supplier for it. ABNs only apply if 

you are in the Original Medicare Plan. 

They do not apply if you are in a 

Medicare Advantage Plan. 

Appeal—A special kind of complaint 

you make if you disagree with certain 

kinds of decisions made by Medicare or 

your health or prescription drug plan. 

You can appeal if you request a health 

care service, supply or prescription that 

you think you should be able to get, or 

you request payment for health care you 

already received, and Medicare or a plan 

denies the request. You can also appeal if 

you are already receiving coverage and 

the plan stops paying. There is a specific 

process your plan must use when you 

ask for an appeal. 

Assignment—In the Original 

Medicare Plan, assignment means a 

doctor or supplier agrees to accept the 

Medicare-approved amount as full 

payment. If you are in the Original 

Medicare Plan, it can save you money if 

your doctor or supplier accepts 

assignment. You still pay your share of 

the cost of the doctor’s visit. 

Deductible—The amount you must 

pay for health care before Medicare 

begins to pay, either for each benefit 

period for Part A, or each year for Part B. 

These amounts can change every year. 

Medicare Administrative 

Contractor (MAC)—private 

company that contracts with Medicare 

to pay Part A and Part B bills. 

Medicare-Approved 

Amount—The fee Medicare sets as 

reasonable for a covered medical service. 

This is the amount a doctor or supplier 

(that accepts assignment) is paid by you 

and Medicare for a service or supply. It 

may be less than the actual amount 

charged by a doctor or supplier. The 

approved amount is sometimes called the 

“Approved Charge.” 

Medicare Advantage Plan—A 

plan offered by a private company that 

contracts with Medicare to provide you 

with all your Medicare Part A and 

Part B benefits.In most cases, Medicare 

Advantage Plans also offer Medicare 

prescription drug coverage. 8 
Words To Know
 

Medicare Summary Notice 

(MSN)—A notice you get after the 

doctor or provider files a claim for 

Part A and Part B services in the 

Original Medicare Plan. It explains what 

the provider billed for, the 

Medicare-approved amount, how much 

Medicare paid, and what you must pay. 

Original Medicare Plan—A 

fee-for-service health plan that lets you 

go to any doctor, hospital, or other 

health care provider who accepts 

Medicare. You must pay the deductible. 

Medicare pays its share of the 

Medicare-approved amount, and you 

pay your share (coinsurance). The 

Original Medicare Plan has two parts: 

Part A (hospital insurance) and Part B 

(medical insurance). 

Skilled Nursing Facility—A 

nursing facility with the staff and 

equipment to give skilled nursing care 

and/or skilled rehabilitation services and 

other related health services. 

State Health Insurance 

Assistance Program (SHIP)—A 

state program that gets money from the 

Federal Government to give free health 

insurance counseling and assistance to 

people with Medicare. 

9 
U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Centers for Medicare & Medicaid Services 

7500 Security Boulevard 

Baltimore, MD 21244-1850 

Official Business 

Penalty for Private Use, $300 

CMS Pub. No. 11021 

Revised December 2006 

To get this booklet in Spanish, call 

1-800-MEDICARE (1-800-633-4227). 

TTY users should call 1-877-486-2048. 

Para obtener este folleto español, llame GRATIS 

al 1-800-MEDICARE (1-800-633-4227). 

TTY 1-877-486-2048 para personas con 

impedimentos auditivos o del lenguaje oral.