Understanding Medicare Coverage for Air Ambulance TransportationSep 08, 2017
Understanding Medicare Coverage for Air Ambulance Transportation
Is an air ambulance a financially practical choice for the senior living with Medicare insurance? It’s a question that comes up frequently because there are some limitations with health insurance in general and even more it seems with Medicare. The answer is yes, but it’s important to understand how air transportation fits into the Medicare plan.
Understanding the Limitations
Medicare B covers all ambulance services, in general, but mostly for medical emergencies and transport to and from facilities. The medical emergency rule is limited to scenarios when it is not safe for the patient to travel via car or taxi.
Emergency air transport coverage depends on two factors:
- Isolation of the patient
- Distance to travel
Put simply, if the patient is situated in a hard to reach area via ground transport, Medicare will approve an air ambulance. The other stipulation is distance – if the patient must travel a great distance to reach the nearest facility, you may use a medical air transport service.
Medicare and Rural Transport
Medicare does offer additional advantages for patients who are in a rural area where medical service is often limited. The medical necessity rule changes in rural areas where medical care is scarce. If a physician or another medical professional determines the patient needs an airlift to a hospital, Medicare allows for it, but only if the air transport meets their established protocols including having the right licenses and insurance.
Non-emergency air transport is available if the travel is necessary for a diagnosis or treatment and there is no other way to get there. Any ambulance transport for a non-emergency, air or ground, requires an order from a physician or other healthcare professional. If the service feels Medicare may not pay, they must provide an Advance Beneficiary Notice (ABN) to alert the patient and family of the potential cost. If you refuse to sign the ABN, the transport professionals will asess the situation and determine if you need immediate transport.
What Medicare Pays
Medicare does not cover the full cost of air transportation but pays the bulk of it when approved after the deductible is met. The patient or responsible party still pays for 20 percent of the Medicare-approved amount.
If you have questions about your Medicare coverage, let us help. Give MEDWAY a call and one of our experts can go over the rules with you to request a medical flight.