Ambulance transportation billing questions are among the most complex inquires received by the MA SMP Program. It is daunting for Medicare and Medicaid beneficiaries to understand their coverage and what they will ultimately be responsible to pay. The MA SMP Program strongly encourages Medicare beneficiaries to know and understand their ambulance benefits BEFORE they have an emergency and need to call an ambulance.
In general Medicare pays 80 percent of the Medicare approved coverage amount for an ambulance trip for those enrolled in traditional Medicare. The beneficiary and/or their supplemental plan, will be responsible for the remaining 20 percent and any deductible. If Medicare denies payment, the supplemental insurance will not pay.
For those enrolled in Medicare Advantage plans the same Medicare rules usually apply. However, there may be applicable co-pays and deducible for every trip.
Before enrolling in a Medicare insurance plan, be sure to ask your insurance company about any co-payments and/or deductibles you will be responsible for paying. When choosing a Medicare insurance plan, make sure you consider the cost of ambulance coverage just as you would consider medical and prescription coverage. Less expensive insurance premiums often result in more expensive deductibles and co-payments.
The MA SMP Program strongly encourages all Medicare and Medicaid beneficiaries to meet with a SHINE counselor once a year to determine what coverage is right for their individual needs. To reach a SHINE counselor call your local Council on Aging or MassOptions at 1-800-243-4836.
To address the many complexities related to ambulance billing the MA SMP Program convened a task force. Click here to learn more about the MA SMP Ambulance Task Force.
For the latest information on what Medicare does and does not cover click here to download the MA SMP Program’s ambulance brochure.
If you suspect fraud or abuse, contact the Massachusetts Senior Medicare Patrol (SMP) Program at 800-892-0890.