RAO Davao City

United States Military Retiree Activities Office Davao City, Philippines

MEDICARE AMBULANCE COVERAGE August 15, 2008

Posted by Service Officer on August 14th, 2008

If it is an emergency Medicare will generally cover ambulance services, as long as an ambulance is the only safe way to transport you (medically necessary); and you are transported to and from certain locations. If covered, Medicare will pay for 80% of its approved amount for the ambulance service. You or your supplemental insurance policy will be responsible for the remaining 20%. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full. If it is not an emergency, Medicare coverage of ambulance services is very limited. An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse. If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered an emergency. Medicare will never pay for ambulette services (i.e. use of specially equipped motor vehicles for transporting convalescing or handicapped people). Also, lack of access to alternative transportation alone will not justify Medicare coverage. Medicare may cover non-emergency ambulance services if:

 

You are confined to your bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair); or

You need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions; or

The hospital where you are receiving treatment is local, or is the closest facility that can provide the treatment you need; or

The cost of bringing treatment to your home is less than the cost of transporting you to the hospital and back by ambulance (for frequent trips, Medicare may require proof that the regular ambulance trips are more appropriate than hospitalization); or

The ambulance meets Medicare requirements.

For Medicare to cover transportation by ambulance the service must be provided within your service area and be medically necessary. If your service area does not have a facility that is adequately equipped or capable of treating you, transport to the closest appropriate facility will be covered. The service area is the geographical region around a facility that contains most of the patients whom the facility serves. For example, if you live in a town with a small community hospital and there is a larger urban hospital 20 miles away, the larger hospital would be part of your service area if it regularly serves people who live in your town. To find out what facilities are in your service area, contact your Medicare Part B carrier by calling 800-MEDICARE. Medicare will cover ambulance services to and from the following locations within your service area:

From your home, or any other place where the need arose to the closest appropriate hospital or skilled nursing facility (SNF).

From a hospital or SNF to your home if the facility is the closest appropriate one in relation to your home.

From a SNF to the nearest medical provider, if the SNF cannot provide you necessary treatment and the cost of transport is less then bringing the treatment to you, and back.

From your home to the nearest appropriate renal dialysis facility, and back.

[Source: Medicare Rights Center 12 Aug 08 ++]

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