Ambulance and emergency room coverage

Ambulance

• Emergency ground ambulance: covered to a hospital, critical access hospital, rural emergency hospital or skilled nursing facility when traveling any other way could endanger your health.
• Air ambulance: may be covered when you need fast transport that a ground ambulance can't provide.
• Non-emergency ambulance: may be covered with a written order from your doctor saying it's medically necessary, for example to and from dialysis.
• Medicare only pays to take you to the nearest facility that can give you the care you need.

You pay 20% of the Medicare-approved amount after the Part B deductible. For a non-emergency trip the company thinks Medicare won't cover, it must give you an Advance Beneficiary Notice first.

Regular scheduled trips: if you need non-emergency ambulance rides often (3 or more round trips in 10 days, or one a week for 3 weeks or more), you or the ambulance company may need Medicare's approval before the fourth round trip in 30 days. Without it, Medicare will deny the claims and the company may bill you.

Emergency room

Part B covers emergency department care for an injury, a sudden illness or an illness that quickly gets much worse. You pay a copay for each ER visit and for each hospital service, plus 20% of the Medicare-approved amount for the doctors' services, after the Part B deductible.

If the hospital admits you as an inpatient for a related condition within 3 days, you don't pay the ER copays, because Medicare counts the visit as part of your inpatient stay.

Inpatient or observation?

You're an inpatient only when the hospital formally admits you with a doctor's order. If you're kept for observation, you're an outpatient, even if you stay overnight. That changes what you pay and whether Medicare covers skilled nursing care afterward.

• Ask each day whether you're an inpatient or an outpatient.
• If you're under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice (MOON) explaining why.
• If the hospital changes you from inpatient to observation, you may be able to ask for a fast appeal while you're still there.

With Medicare Advantage or Medigap

Medicare Advantage plans cover emergency care even outside their network, with their own copays. Medigap can pay some or all of your share with Original Medicare. For emergencies abroad, see Medicare when you travel.