Does Medicare Cover an Air Ambulance?
- Does Medicare cover an air ambulance? Medicare pays for many of the unavoidable costs of seniors’ medical care. Find out how much of your air ambulance trip is covered.
Medicare pays some of the cost of air ambulance transportation, provided your trip meets the program’s Part B eligibility standards for prehospital transit services. Part B benefits pay up to 80% of the cost for medically necessary transportation, leaving the other 20% for your Medicare supplemental policy or out-of-pocket payments to cover.
How Does Medicare Pay for Transportation?
Original Medicare provides its benefits through three parts, known as Parts A, B and D. Part A pays most of the cost for inpatient hospitalization, and Part D is the prescription drug benefit. Most transportation and other outpatient expenses are covered through Medicare Part B. Part B benefits pay a substantial portion of outpatient services, office visits and allied care, including air and ground transportation services.
Many Medicare beneficiaries get their coverage through a Medicare Advantage, or Part C, plan. By law, Medicare Part C plans include all of the same benefits of Original Medicare Parts A and B. Many Medicare Advantage plans also include extra benefits enrollees need, such as vision and dental care. Because Part C plans include all of the same benefits as Original Medicare Part B plans, air ambulance services get substantially the same coverage for Medicare Advantage enrollees.
What Is an Air Ambulance?
The term air ambulance refers to any medical transportation service that uses helicopters or fixed-wing aircraft to transport people for treatment. Sometimes this is done for emergency transport to the hospital, such as when people are injured in remote locations or an incident commander believes ground transportation is too slow for the person’s medical needs. Air transportation is also an option for facility transfers, such as inter-city trips between hospitals or trips out-of-state for needed medical care.
Most air ambulance services employ both paramedics and mobile intensive care nurses on their flights. Paramedics provide expert prehospital care, and flight nurses can monitor passengers’ conditions throughout the trip. Specialist care is often available during air ambulance flights, such as pediatric and hospice nurses.
Is Your Air Ambulance Trip Covered by Medicare?
In most cases, air ambulance services are paid for in a way very similar to ground ambulance trips. Because Medicare’s standard Part B coverage requires medical necessity for outpatient services, it may be necessary to get approval for nonemergency trips in advance. Emergency air ambulance transportation is generally covered like any other necessary emergency service.
How Much Does Medicare Pay for Air Ambulance Transportation?
Medicare Part B typically pays 80% of the cost for covered services, including air ambulance trips. In order to get this support, you usually have to pay a monthly premium for your Part B coverage, along with meeting the annual deductible, which in 2021 is $203. Thus, a trip by air that costs $40,000 is likely to cost $39,797 after the deductible, leaving $31,837.60 to be paid by Medicare and $7,959.40 unpaid by your benefits.
How to Cover the Unpaid Costs of Medical Air Transportation
Most air ambulance rides leave a large unpaid balance for Medicare beneficiaries to pay. If you have Part B coverage, your benefits can pay up to the first 80% of the bill, but you do not necessarily have to pay out of pocket for the rest.
Many Medicare participants carry secondary insurance that is designed specifically to plug the gaps left by Medicare plans. These Medicare supplemental plans usually charge a monthly premium of their own, as well as impose a deductible and annual spending cap, but they can be extremely helpful in picking up the unpaid cost of air ambulance rides and other high-price services.
In the example above, for instance, a Medicare Part B participant would be left owing nearly $8,000 after their Medicare benefits were exhausted. With a Medicare supplemental plan that capped out at $10,000, this ride could wind up costing just $203, which in this case would be the Part B deductible.
Medicare supplemental plans are issued by private insurance companies and terms of coverage vary widely. Speak with a plan representative in your area who can quote you coverage limits and explain what air ambulance services are covered under the policy.
Health Savings Accounts (HSA)
Health savings accounts are a type of tax-free private savings system that you can use to pay for medical and health-related expenses. Money you earn can be deposited into a health savings account in advance, usually without being taxed, and then withdrawn as your healthcare needs demand. Because air ambulance transportation is a Part B benefit, you can probably use funds from your HSA to pay the coinsurance amount without penalties. Speak with a financial advisor to be sure of your tax situation.
Medicare beneficiaries with limited income and assets may be able to use their states’ Medicaid program as a supplemental policy. If you are dual-eligible, your air ambulance ride may be completely covered by your insurance. After your Part B deductible is paid, Medicare pays the standard 80% for your trip by air. After that, any unpaid costs may be submitted to Medicaid for payment. Ask a Medicaid worker in your state whether you need prior approval for nonemergency air ambulance transportation.
What makes an air ambulance medically necessary?
When you need to travel to a medical facility for care, your doctor or other healthcare worker can decide whether you need medical supervision and care during transportation. Air ambulance trips are considered medically necessary if they are ordered on an emergency basis, or if your provider believes it is the safest way to transfer you between facilities.
How much does an air ambulance trip cost?
Air ambulance services in the United States typically cost more than $40,000. Depending on the services provided and the distances traveled, costs can approach $100,000 for a single ride.
What kind of care can you get during an air ambulance ride?
Passengers in an air ambulance get all of the same services that are provided in a ground ambulance. Life-saving care, health monitoring and limited medical interventions can all be provided by the paramedic and nurse on a typical air ambulance.
Why would Medicare deny payment for an air ambulance service?
Medicare might refuse to pay for services under Part B for a number of reasons. Some of the most common reasons for denying air ambulance services include lack of medical necessity and the use of a service that doesn’t have authorization to bill Medicare.
What can you do if Medicare denies payment for your trip by air?
If you believe that Medicare has mistakenly rejected your payment request, you might get the decision reversed by filing an appeal. If Medicare continues to refuse payment, your other insurance coverage, such as Medicaid, might be able to help.