In this guide 4 sections
When someone cannot transfer without a lift, the facility and doctor should determine what type of transportation is safe. Medicare may cover an ambulance when transportation in another vehicle would endanger the person’s health, but lift assistance alone does not establish coverage.
Start with the skilled care facility
- 1.Ask the nurse, social worker or transportation coordinator to review the appointment and her transfer needs.
- 2.Ask whether she is currently in a Medicare covered Part A skilled nursing facility stay. This can affect who arranges and bills for transportation.
- 3.Ask the doctor whether another vehicle would endanger her health. If so, request a written order explaining why ambulance transportation is medically necessary.
- 4.Before the trip, ask the facility and ambulance company how the service will be billed and what she may owe.
When Medicare may cover the ambulance
Medicare Part B covers ground ambulance transportation when travel in another vehicle could endanger the person’s health and medically necessary transportation is needed. For some nonemergency trips, Medicare may require a written order from a doctor or other health care provider.
During a Medicare covered skilled nursing facility stay, covered services can include ambulance transportation to the nearest supplier of needed services that are not available at the facility, when another form of transportation would endanger the resident’s health.
Check who is responsible for the bill
Medicare’s skilled nursing facility billing rules depend on whether the resident is in a covered Part A stay and what service requires the trip. Some ambulance trips are included in skilled nursing facility billing, while certain trips are separately billable. The facility should verify the billing route before scheduling transportation.
If an ambulance company believes Medicare may not cover a nonemergency trip, it must give the patient an Advance Beneficiary Notice of Noncoverage when Medicare’s notice requirements apply. Read the notice and ask about the full charge before deciding whether to take the trip.
If an ambulance is not covered
If the care team says an accessible nonambulance vehicle is safe, contact the Eldercare Locator. It connects older adults and families with local aging services. Call 1-800-677-1116 or search online.
Questions families ask
Does Medicare cover an ambulance because she cannot walk or transfer alone?
Not automatically. Medicare looks at whether transportation in another vehicle would endanger her health and whether ambulance transportation is medically necessary. Ask her doctor and facility to document the reason.
Does the skilled care facility have to arrange the ride?
The answer can depend on whether she is in a Medicare covered Part A skilled nursing facility stay and on the service she is leaving the facility to receive. Ask the facility’s billing office or social worker to confirm who must arrange and bill for the trip.
What if the ambulance company says Medicare might deny the trip?
For a nonemergency ambulance trip, the company must provide an Advance Beneficiary Notice of Noncoverage when it believes Medicare may not pay and the notice requirements apply. Ask for the expected charge before signing.
Where can the family ask about local aging services?
Call the Eldercare Locator at 1-800-677-1116. It connects older adults and families with local aging services.
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