You never know when you’ll need an ambulance. And when you do need an ambulance, you can never be quite sure what it will cost you—not that you’ll be thinking about that in the first place. While many insurance companies do offer ambulance coverage, not all of them will. Still, should your insurance company cover your ambulance ride, you may end up paying more than you might expect. Ambulance insurance coverage is an important part of your medical coverage to pay attention to for these reasons. Whether you expect to use ambulance services or not, read on to learn more about ambulance insurance coverage and what you should know.
Coverage Under the ACA
Under the Affordable Care Act, emergency care including ambulance rides are considered medically essential, so most insurance companies must cover them unless the ambulance delivers them to a clinic or office where emergency care is not given. Ambulance coverage also includes air ambulance coverage if medically necessary. Provided you meet all of the requirements, both private insurance and Medicare should cover your ambulance ride, but you may still need to cover other costs.
- Affordable Care Act deems ambulance coverage essential
- Must be delivered to emergency facility
- Air ambulance also covered
Coverage by Medical Facility
The cost of getting in an ambulance will depend on a number of factors. Where you are taken will greatly impact the cost to you as you may be taken to a location that does not cover you, so while your ambulance may be covered, the actual emergency care will not be. Another thing to pay attention to is the driver of the ambulance. Ambulances that are out of network will end up costing you more. Unfortunately, sometimes you might not even have the option of an in-network ambulance.
- Depends on driver
- Depends on location
- Depends on in-network or out of network
Medical Necessity Ambulance Trips
It is extremely important not to overestimate the severity of your medical emergency. If you are feeling sick or hurt and choose an ambulance just because you don’t want to drive, it may come with consequences. If the insurance company does not deem your ambulance ride a medical necessity, then the insurance company may refuse to cover it. An ambulance ride is deemed a medical necessity when a patient is suffering from severe pain or bleeding, or they are in a state of shock or unconscious. If they are in need of oxygen or other medical treatment on the way to the hospital, then the insurance company will usually cover these situations.
- Must be incapacitated
- Must need care on way to hospital
- Must be bleeding
Medicare Ambulance Coverage
Medicare will generally cover 80 percent of the Medicare-approved amount, provided you’ve paid your Medicare Part B deductible. Therefore, Medicare patients will have to pay around 20% of the ambulance cost and any necessary deductibles. However, with a Medicare advantage plan, you could reduce or eliminate those costs depending on your policy. Only a few situations will disqualify you from ambulance coverage, including electing to go to a farther emergency facility and moving to other facilities.
- Will cover 80%
- Medicare advantage needed to cover other 20%
- Must not unnecessarily transfer
Because you cannot predict when you’ll have an emergency, it’s important to know what your insurance will cover regarding ambulance rides. While most insurance will cover them, you may end up having to pay more for unnecessary services.