Medicare Ambulance Bills: Coverage Rules and Your Share of the Cost

Adapted from Medicare Coverage of Ambulance Services, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Medicare coverage of ambulance services

Medicare Part B (Medical Insurance) covers ambulance services to or from a hospital, critical access hospital (CAH), rural emergency hospital, or a skilled nursing facility. Medicare covers and helps pay for ambulance services only when other transportation could endanger your health, like if you have a health condition that requires this type of transportation.

In some cases, Medicare may also cover ambulance services if you have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) and need ambulance transportation to or from a dialysis facility.

Medicare will only cover ambulance services to the nearest appropriate medical facility that can give you the care you need. If you choose to be transported to a facility farther away, Medicare will only pay up to what it costs to take you to the closest facility that can give you the care you need. If no local facilities can give you the care you need, Medicare will pay for transportation to the nearest facility outside your local area that can give you the care you need.

Emergency ambulance transportation

You can get emergency ambulance transportation when you’ve had a sudden medical emergency, your health is in serious danger, and you can’t be safely transported by other means, like by car or taxi.

Medicare might cover emergency ambulance transportation when:

• You’re in shock, unconscious, or bleeding heavily.
• You need skilled medical treatment during transportation.

Remember, these are only examples. Medicare coverage depends on the seriousness of your medical condition and if you could’ve been safely transported by other means.

Air transportation

Medicare may pay for emergency ambulance transportation in an airplane or helicopter if your health condition requires immediate and rapid ambulance transportation that ground transportation can’t provide, and one of these applies:

• Your pickup location can’t be easily reached by ground transportation.
• Long distances or other obstacles, like heavy traffic, could stop you from getting care quickly if you traveled by ground ambulance.

Non-emergency ambulance transportation

You may be able to get non-emergency ambulance transportation if you need it to treat or diagnose your health condition, and using any other transportation method could endanger your health.

In some cases, Medicare may cover limited, medically necessary, non-emergency ambulance transportation if your doctor writes an order stating that you need it due to your medical condition. Even if a situation isn’t an emergency, ambulance transportation may be medically necessary to get you to a hospital or other covered health facility.

Medicare prior authorization program If you get scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period or at least once a week for 3 weeks or more, you may be affected by the Medicare prior authorization program. Under this program, your ambulance company may send a request for prior authorization to Medicare, so you and the company will know earlier in the process if Medicare is likely to cover your services. The Medicare benefit isn’t changing.

Either you or your ambulance company may request prior authorization for these repeated, scheduled, non-emergency ambulance services. If your prior authorization isn’t approved and you continue getting these services, Medicare will deny the claim and the ambulance company may bill you for all charges. For more information, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Visit Medicare.gov/coverage/ambulance-services for the latest updates on the Medicare prior authorization program for ambulance services.

“Advance Beneficiary Notice of Non-coverage” (ABN)

When you get ambulance services in a non-emergency situation, the ambulance company considers if Medicare may cover the transportation. If Medicare would usually cover it, but the ambulance company believes Medicare may not pay for your particular ambulance service because it isn’t medically reasonable and necessary, the ambulance company must give you an “Advance Beneficiary Notice of Non-coverage” (ABN) to charge you for the service. The ambulance company won’t ask you to sign an ABN in an emergency. An ABN is a notice that a doctor, supplier, or provider gives you before furnishing an item or service if they believe Medicare may deny payment.

ABNs have options that allow you to choose if you want the service and explain your responsibility to pay for the service. If you choose the option showing you want and will pay for the service, and you sign the ABN, you’re responsible for paying if Medicare doesn’t. The ambulance provider or supplier may ask you to pay at the time of service.

Example: Mr. Smith is a hospital inpatient and needs to travel to a different hospital for a procedure that he can’t get in the hospital where he was admitted. Mr. Smith requires ground ambulance transportation because of his medical conditions, but he asks for air ambulance transportation instead. Medicare will cover the cost of the ground ambulance transportation, but it won’t cover air ambulance transportation because this level of service isn’t medically reasonable or necessary. The ambulance company must give Mr. Smith an ABN before transporting him by air ambulance, or the ambulance company will be responsible for any costs over the amount that Medicare would’ve paid for ground ambulance transportation.

Note: If you’re in a situation that requires an ambulance company to give you an ABN and you refuse to sign it, the ambulance company will decide whether to take you by ambulance. If the ambulance company decides to take you and Medicare doesn’t pay, you may still be responsible for the cost of the trip, even though you refused to sign the ABN.

Voluntary ABN

If an ambulance company believes that Medicare won’t cover an ambulance service because it doesn’t meet Medicare’s definition of a covered service, it may give you a voluntary ABN as a courtesy. When this happens, the ambulance company isn’t required to give you an ABN to bill you for the service. If the ambulance company gives you a voluntary ABN, you aren’t required to choose an option or sign it. In this situation, the ambulance company expects that Medicare won’t pay for the service, and you’ll be responsible for the cost of the trip.

Example: Mrs. Lee falls in her front yard and her neighbor calls an ambulance. She isn’t in distress, but she can’t stand up without having ankle pain. When the ambulance arrives, Mrs. Lee wants to go to the hospital, but she doesn’t have a serious medical emergency and her health won’t be in danger if she goes to the emergency room another way (like a car or taxi). Since Mrs. Lee could get to the hospital by another type of transportation without a serious risk to her health, Medicare won’t cover the ambulance transportation. In this situation, the ambulance company isn’t required to give Mrs. Lee any formal notice, but out of courtesy, they may give her an ABN so that she knows she’ll be billed for this service.

If Medicare doesn’t pay for your ambulance trip and you believe it should have, you can file an appeal. You must actually get the service and a claim for payment must be sent to Medicare, before you can file an appeal. Go to page 8 for more information about your rights.

Paying for ambulance services

If Medicare covers your ambulance trip, you pay 20% of the Medicare-approved amount after you’ve met the yearly Part B deductible.

In most cases, the ambulance company can’t charge you more than 20% of the Medicare-approved amount and any unmet Part B deductible. All ambulance companies must accept the Medicare-approved amount as payment in full.

Note: If a critical access hospital (CAH) or an entity owned and operated by a CAH transports you, what you and Medicare pay may be different.

If Medicare covers your ambulance trip, Medicare will pay 80% of the Medicare-approved amount after you’ve met the yearly Part B deductible. Medicare’s payment may be different if you’re transported by a CAH or an entity that’s owned and operated by a CAH.

How do I know if Medicare didn’t pay for my ambulance service?

You’ll get a “Medicare Summary Notice” (MSN) in the mail every 4 months that lists all the services billed to Medicare, including ambulance services. Your MSN will tell you if Medicare didn’t pay for your ambulance trip and why. You can also get your MSN electronically by going to Medicare.gov/account to log into (or create) your secure Medicare account.

MSN examples for why Medicare didn’t pay for your ambulance trip:

• You chose to go to a facility farther than the closest one, so your notice says: “Payment for transportation is allowed only to the closest facility that can provide the necessary care.”
• You used an ambulance to move from one facility to another one closer to home, so your notice says: “Transportation to a facility to be closer to a home or family is not covered.”

Remember, these are only examples of statements you may find on your MSN. Statements vary depending on your situation. If you have questions about what Medicare paid, call the phone number on your MSN or 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Medicare rights & protections

What can I do if Medicare doesn’t pay for an ambulance trip?

If Medicare doesn’t pay for an ambulance trip that you think should be covered, you or someone you trust can review your Medicare Summary Notice (MSN) and any other paperwork related to your ambulance bill. You may find errors that can be fixed.

For example, while reviewing your Medicare Summary Notice (MSN) and other paperwork, you may find that Medicare denied your claim for one of these reasons:

• The ambulance company didn’t fully document why you needed ambulance transportation. If this happens, you can contact the doctor who treated you or the discharge social worker to get more information about your need for ambulance transportation. You can send this information to the company that handles bills for Medicare or ask your doctor to send it. The company’s address is on your MSN.
• The ambulance company didn’t file the proper paperwork. If this happens, you can ask the ambulance company to refile your claim. If refiling your claim doesn’t result in payment, you can file an appeal.

What if Medicare still won’t pay?

If you have Medicare, you have certain guaranteed rights, including the right to appeal decisions about payment or coverage of services.

If Medicare doesn’t cover your ambulance trip, and you think your trip should’ve been covered, you have the right to file an appeal. To file an appeal:

1. Review your MSN. It will tell you why your bill wasn’t paid, how long you have to file an appeal, and what steps you need to take.

2. Carefully follow the instructions on your MSN, sign it, and send it to the address of the company listed on your MSN. You may also include a letter explaining why you believe the ambulance trip should’ve been covered.

3. Ask your doctor or health care provider for any information that may help your case and attach copies to your signed MSN.

4. Keep a copy of everything you send to Medicare as part of your appeal.

Or, you can complete CMS Form 20027 and file it with the Medicare contractor at the address listed on your MSN. To view or print this form, visit CMS.gov/cmsforms/ downloads/cms20027.pdf, or call 1-800-MEDICARE (1-800-633-4227) to find out if a copy can be mailed to you. TTY users can call 1-877-486-2048.

If you need more information or help filing an appeal:

• Visit Medicare.gov/claims-appeals/how-do-i-file-an-appeal.
• Call your State Health Insurance Assistance Program (SHIP). Visit shiphelp.org, or call 1-800-MEDICARE to get the phone number.

CMS Accessible communications

Medicare provides free auxiliary aids and services, including information in accessible formats like braille, large print, data or audio files, relay services and TTY communications. If you request information in an accessible format, you won’t be disadvantaged by any additional time necessary to provide it. This means you’ll get extra time to take any action if there’s a delay in fulfilling your request.

To request Medicare or Marketplace information in an accessible format you can:

1. Call us: For Medicare: 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048 For Marketplace: 1-800-318-2596 TTY: 1-855-889-4325

2. Email us: altformatrequest@cms.hhs.gov 3. Send us a fax: 1-844-530-3676 4. Send us a letter: Centers for Medicare & Medicaid Services Offices of Hearings and Inquiries (OHI) 7500 Security Boulevard, Mail Stop DO-01-20 Baltimore, MD 21244-1850 Attn: Customer Accessibility Resource Staff (CARS)

Your request should include your name, phone number, type of information you need (if known), and the mailing address where we should send the materials. We may contact you for additional information.

Note: If you’re enrolled in a Medicare Advantage Plan or Medicare drug plan, contact your plan to request its information in an accessible format. For Medicaid, contact your state or local Medicaid office.

Source and further reading

Medicare Coverage of Ambulance Services — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.