Medicare provides limited ambulance-cost coverage

Dear Savvy Senior:

How does Medicare cover ambulance services? About three months ago, I took an ambulance to the emergency room because I rarely drive, and I just received a $1,100 bill from the ambulance company. — Surprised Senior

Dear Surprised: This is a confusing Medicare issue. Yes, Medicare covers emergency ambulance services and, in limited cases, non-emergency ambulance services, but only when they’re deemed medically necessary and reasonable.

That first means your medical condition must be serious enough that you need an ambulance to transport you safely to a hospital or other facility where you receive care that Medicare covers.

If a car or taxi could transport you without endangering your health, Medicare won’t pay.

For example, Medicare probably won’t pay for an ambulance to take someone with a simple arm fracture to a hospital. But if he or she goes into shock or is prone to internal bleeding, ambulance transport may be medically necessary to ensure the patient’s safe transport. The details make a difference.

Second, the ambulance must take you to the nearest appropriate facility, meaning the closest hospital, critical access hospital, skilled nursing facility or dialysis facility generally equipped to provide the services your illness or injury requires.

It also means that the facility must have a physician or physician specialist available to treat your condition. Thus, Medicare may pay for an ambulance to take you to a more distant hospital if, for example, you are seriously burned, and the nearest hospital doesn’t have burn unit.

Similarly, if you live in a

rural area where the nearest hospital equipped to treat you is a two-hour drive, Medicare will pay.

But if you want an ambulance to take you to a more distant hospital because the doctor you prefer has staff privileges there, expect to pay a greater share of the bill. Medicare will cover the cost of ambulance transport to the nearest appropriate facility and no more.

In limited cases, Medicare will also cover non-emergency ambulance services if such transportation is needed to treat or diagnose your health condition and the use of any other transportation method could endanger your health. Lack of another means of transportation is not sufficient for Medicare to pay for services.

The cost for ambulance services can vary from several hundred to several thousand dollars depending on where you live and how far you’re transported.

Under original Medicare, Part B pays 80 percent of the Medicareapproved amounts for ambulance rides. You, or your Medicare supplemental policy (if you have one), will need to pay the remaining 20 percent.

If you have a Medicare Advantage Plan, it must cover the same services as original Medicare, and it may offer some additional transportation services. Check with your plan for details.

Send senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit Savvysenior.org.