Medicare only covers ambulance trips to the hospital or skilled nursing facility under certain circumstances. A person who falls down his stairs and sprains his wrist should find a way to get to the hospital that does not involve paramedics of EMTs. If on the other hand, he is bleeding to death, Medicare will pay for an ambulance trip on this occasion. The determining factor is whether or not a person’s life is endangered if he does not ride in the ambulance. The frugal rules covering when a person qualifies for coverage for an ambulance trip may cause some confusion at first, but they are relatively easy to understand.
Medical helicopters can transport patients from location to location quickly. Medicare will only pay its full coverage cost if it is an emergency and no ground transportation is available. If ground transportation is available and a hospital decided to use a helicopter to transfer the patient anyway, Medicare will only reimburse the costs for ground transportation. The remaining costs must come from a person’s own pocket or from some other insurance company. Blizzards, storms and other conditions that made ground transportation impossible also are factored into the decision of how much Medicare will pay for transportation.
Although ambulance trips are not the most expensive item Medicare covers, the program needs to find anyway it can to keep costs down, especially with the Baby Boom generation turning 65 years old. Discouraging unnecessary trips to a hospital or skilled nursing facility that involve an ambulance is one way to do it. First responders or doctors often make this determination for the patient. If Medicare denies coverage for an ambulance trip, a beneficiary can appeal the decision by going through the sometimes lengthy appeals process.