Does Medicare Cover Ambulance Rides in Texas? Ground, Air, and What You'll Pay

When someone calls 911, the bill is the last thing on anyone's mind. But in a state as big and rural as Texas, the nearest hospital that can handle a stroke or a serious injury may be a long way off, and an ambulance ride can be long and costly. It helps to know how Medicare handles ground and air ambulances before you need one.

When Part B covers a ground ambulance

Part B covers emergency ground ambulance transport when you need medically necessary care at a hospital, critical access hospital, rural emergency hospital, or skilled nursing facility, and any other way of getting there could endanger your health.

Medicare's examples include:

• Being in shock or unconscious
• Bleeding heavily
• Needing skilled medical treatment during the ride

Air ambulance: the Texas question

Distance is a real factor here. According to the Texas Department of Agriculture's State Office of Rural Health, 177 of Texas's 254 counties are rural. In much of the state, reaching specialized emergency care can mean a long trip.

Medicare may cover emergency air transport by helicopter or airplane when your condition needs immediate, rapid transport that ground transportation can't provide, and either:

• Your pickup spot is hard to reach by ground, or
• Distance or other obstacles, like heavy traffic, could delay the care you need

Coverage depends on your condition at the time, not just where you live. Being far from a hospital alone doesn't guarantee Medicare will pay for a helicopter if a ground ambulance could have safely made the trip.

Which hospital Medicare pays to reach

Medicare covers transport to the nearest appropriate facility that can give you the care you need. In rural Texas, that rule cuts both ways:

• If your local hospital can't treat your condition, Medicare covers the trip to the nearest one that can, even if it's in another county or city.
• If you choose to go farther than necessary, Medicare pays only up to what the trip to the nearest appropriate facility would have cost.

Non-emergency rides

Part B covers non-emergency ambulance trips only in limited cases, when an ambulance is needed to diagnose or treat your condition and other transportation could endanger your health. You'll generally need a written order from your doctor saying it's medically necessary. Rides to and from dialysis for someone with end-stage renal disease are one example. Our guide to Medicare and dialysis in Texas covers the rest of what Medicare pays for kidney failure.

For repeated scheduled trips, such as three or more round trips in 10 days, the ambulance company may ask Medicare for prior authorization. If it's denied and the rides continue, you could be billed for the full cost.

If you're asked to sign an ABN

For a non-emergency ride Medicare may not cover, the ambulance company must give you an Advance Beneficiary Notice of Non-coverage (ABN). It explains that you may have to pay.

• In an emergency, you won't be asked to sign an ABN.
• If you sign one, you're agreeing to pay if Medicare denies the claim. You can still ask the company to bill Medicare, which keeps your right to appeal.

How other coverage helps

• Medigap policies help pay your share of costs under Original Medicare, depending on the policy.
• Medicare Advantage plans cover everything Original Medicare does, though their copays can differ, and they have a yearly limit on what you pay for covered Part A and Part B services. Check each plan's ambulance costs.
• Texas Medicare Savings Programs, like QMB, can help with Medicare deductibles and coinsurance for people with limited income. Limits change yearly; see our guide to Part B premium help in Texas.

After the ride

Check your Medicare Summary Notice for the claim. Our guide to reading your Medicare Summary Notice shows what to look for. If you were charged more than your share, or the claim was denied, call the ambulance company first, then consider an appeal. Texas HICAP counselors can help for free at 1-800-252-9240.

For more on what Part B covers, see our Part B guide.