Monday, April 27, 2015

Ambulance service? Helicopter transport? What will Medicare pay?

Medicare helps pay for emergency transportation when you've had a sudden medical emergency, and your health is in serious danger because you cannot be safely transported by a car, taxi or other means.

For example, Medicare covers emergency ground ambulance services to a hospital, critical access hospital (CAH), or skilled nursing facility (SNF) when you’re in shock, unconscious, bleeding heavily or you need skilled medical treatment during transportation.

Medicare may also pay for emergency ambulance transportation in an airplane or helicopter if your health condition requires immediate and rapid transportation that cannot be provided by ground services. For example, a life threatening car accident.

Medicare will only cover ambulance services (ground or air) to the nearest appropriate medical facility that’s able to give you the care you need. Coverage for emergency transportation depends on the seriousness of your medical condition and whether you could’ve been safely transported by other means.

Non-Emergency Ground Transportation. Medicare may provide limited, medically necessary non-emergency ambulance transportation if your situation meets the following three conditions: (1) ambulance transport is needed to obtain treatment or diagnose a health condition (2) other transportation would endanger your health and, (3) you have a written order from your doctor stating that ambulance transportation is necessary because of your condition.
For each type of covered ambulance transportation, Medicare pays 80% of the Medicare approved amount after you meet the yearly Part B deductible. Medicare's payment may be different if you get services from a hospital-based ambulance company. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full.

Lack of access to alternative transportation alone will not justify Medicare coverage. Medicare will never pay for ambulette services (a wheelchair-accessible van that provides non-emergency transportation for people with disabilities.)

If you have a Medicare Advantage Plan, Supplement or other Medicare health plan, what you pay and the rules for ambulance coverage may be different.

For more information on Medicare, join me for my class, Getting Started with Medicare where we cover all the basics. You’ll find a complete list of dates and times at classes are for educational purposes only and no plan specific benefits or details will be presented. I hope to see you there.

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