What emergency and ambulance care services are covered under Medicare?

Dear Mahesh, 

If you have Original Medicare, Part B covers emergency room services anywhere in the U.S. Medicare Advantage Plans  must also cover emergency services anywhere in the country. For emergency care, remember that: 

• Your plan can’t require you to see an in-network provider. 
• You don’t need a referral. 
• There are limits on how much your plan can bill you if you receive emergency care  out of your plan’s network. Specifically, you will be billed either $50 or your plan’s in-network cost for emergency services, whichever is less. 
• Your plan must cover medically necessary follow-up care related to the medical emergency if delaying care would endanger your health. 
• You have the right to appeal if your plan denies a claim for emergency care. 

If you have Original Medicare, Part B covers emergency ambulance services if:  

• An ambulance is medically necessary, meaning it’s the only safe way to transport you 
• The reason for your trip is to get a Medicare-covered service or return from getting care 
• You are transported to and from certain locations, And, the transportation provider meets Medicare ambulance requirements 

To be eligible for coverage of non-emergency ambulance services, you must be bedbound or need essential medical services during your trip that are only available in an ambulance. This could include administration of medications or monitoring of vital functions. Original Medicare never covers ambulette services.  

If you have a Medicare Advantage Plan, your plan must cover the same ambulance services that Original Medicare covers but can do so with different costs or network restrictions. Contact your plan directly to learn more about how it covers ambulance transportation.  

If your condition was not an emergency but appeared to be an emergency, Original Medicare or your Medicare Advantage Plan must still cover your care.  

Hope this helps! 

-Marci