Does Insurance Cover Ambulance

Does Insurance Cover Ambulance Rides? Everything You Need to Know

In the United States, healthcare services can be expensive without insurance, and ambulance rides are no exception. Which may make you wonder, “Does insurance cover ambulance rides?”

The answer is: sometimes. Whether or not you receive coverage for ambulance rides depends on the type and scope of your insurance plan(s) in particular. This page details everything you need to know about the relationship between ambulances and insurance so that you can rest easy knowing you’re covered in worst-case scenarios.

While you’re being proactive about understanding which health insurance services you’re covered for, be sure to work with a trustworthy health insurance company that puts a priority on transparent billing and plan management. With a digital-first approach to healthcare, you can do everything you need to do in a couple of clicks, without wasting time or needing to sift through the fine print.

Find in this article:

Which Types of Insurance Cover Ambulance Rides?

Insurance is usually fairly straightforward. For example, if you want to get LASIK, you need vision insurance. If you want to visit a chiropractor, you need health insurance.

Ambulances are a little different. A couple of different types of insurance have the potential to cover your ambulance bills. 

Does car insurance cover ambulance rides?

Car insurance covers ambulance rides if three criteria are met.

  • You are calling an ambulance because you are injured due to being involved in a car accident. In other words, your ambulance ride is directly related to your car insurance policy. 
  • You have purchased personal injury protection (PIP) when you enrolled in your car insurance plan. If you enrolled in a car insurance plan that has the bare minimum coverage required by law, PIP may not be included.
  • The ambulance ride is deemed medically necessary. Your insurance contract will spell out what qualifies as a medical necessity in your contract. For example, feeling neck or back pain, or suffering a more severe injury like a broken bone, will almost always qualify.

When these three criteria are met, you’ll usually receive coverage for your ambulance ride, but with a few restrictions.

  • You will likely be covered only for transportation to the nearest hospital.
  • Only necessary services related to your automotive accident while at the hospital will be covered.
  • Certain insurance policies will provide coverage only if you use an ambulance company that’s within the approved network of medical providers.

Does Health Insurance Cover Ambulance Rides?

Like car insurance, health insurance frequently covers ambulance rides. However, car insurance is usually a better option because using health insurance for ambulance rides comes with certain limitations.

  • With health insurance, you usually need to hit your annual deductible before you are eligible for ambulance coverage. A deductible is a fixed dollar amount that you agree to when you enroll in a new health insurance plan. For example, if your deductible is $2,000, your ambulance ride ends up costing $1,500, and you have not contributed anything to your yearly deductible so far, you could end up receiving no coverage at all for your ambulance ride.
  • Even after you hit your deductible, you may be responsible for paying a copay or coinsurance. A copay is a flat fee associated with certain healthcare services—in this case, an ambulance ride. For example, your copay may be $100 or $200 for an ambulance ride. Coinsurance refers to when you and the insurance company split the bill on a percentage basis. For example, your coinsurance rate may be 80% (paid by your insurance company) and 20% (paid by you, out of pocket).

Although health insurance coverage is usually less comprehensive for ambulance services, it does come in handy for individuals who do not purchase PIP on their car insurance plans, but are then involved in car accidents and need to make use of ambulance services. Overall, the answer to “Does health insurance cover ambulance rides?” is: it depends.

Does Public Health Insurance Cover Ambulance Rides?

Public health insurance refers to a health insurance policy that is sourced from or with the assistance of a state or federal government program. Two popular public health insurance plans are Medicare and Medicaid.

Does Medicare Cover Ambulance Rides?

Medicare is a health insurance program managed by the federal government that offers affordable healthcare plans mostly to individuals who are 65 years of age and older.

Medicare is divided into four parts: A, B, C, and D. You are usually covered for ambulance services if you are enrolled in Medicare part B, which deals with a variety of outpatient healthcare services.

Medicare part B closely resembles private health insurance insofar as it requires you to manage things like deductibles, copays, etc. Therefore, just having Medicare part B may not always entitle you to health coverage for ambulance services.

Does Medicaid Cover Ambulance Rides?

Medicaid is another popular public health insurance plan offered primarily to individuals who may not be able to afford private health insurance plans.

Medicaid covers ambulance services so long as the ambulance company is fully licensed by the state it is operating in.

Outside of emergencies, ambulance services are covered under Medicaid only if you can get your doctor to write a note stating that the ambulance is medically necessary.

When Does Insurance Not Cover an Ambulance Ride?

There are certain situations where you may not receive coverage for an ambulance ride, even if you have a relevant insurance policy.

  • If your ride was deemed not to be medically necessary.
  • If you have restrictions on which ambulance companies you are covered with and use one that is outside of the approved network.
  • In the case of health insurance, if you have not yet met your annual deductible.
  • In the case of car insurance, if you did not purchase PIP when you enrolled in your plan, or if your ambulance bill exceeds the total coverage you purchased under PIP.

How Are Ambulance Fees Calculated?

Some medical services, such as physical examinations, are billed on a flat-rate basis, meaning you pay a fixed amount for the full service. In the case of ambulance rides, the cost is variable rather than fixed, meaning your ambulance ride could end up being affordable—or quite expensive.

Ambulances typically charge based primarily on the number of loaded miles during your trip. A loaded mile counts as a mile where you are being transported by the ambulance—miles incurred on the way to pick you up are usually not counted towards your total. For example, if the cost per loaded mile was $100, and you were transported 10.5 miles, your ambulance fee would be $1,050. 

Ambulance companies sometimes also charge for health services, such as providing oxygen. Overall, ambulance fees have increased substantially in the past five years, and billing practices are not standard throughout the industry.

How Much Is an Ambulance Ride Without Insurance?

The prices ambulance companies set are not regulated by the government, which means if they’re not fixed due to an agreement with an insurance company, charges can add up quickly. Without insurance, you’ll always be on the hook for the full bill.

A recent study estimated that ambulance rides without insurance can cost up to $20,000. 

How Much Is an Ambulance Ride With Insurance?

With insurance, your ambulance ride might be free, assuming you are covered by car insurance, you have purchased a plan that includes personal injury protection, and the bill for your ambulance ride is less than the amount you are covered for through your car insurance policy.

If you’re covered for ambulance rides through a health insurance policy, you may end up having to pay a portion of the bill. The percentage you pay may depend on your coinsurance rates, which should be spelled out in the fine print of your contract. However, if you haven’t yet met your yearly deductible or the ambulance ride is not deemed medically necessary, you could be on the hook for the full bill, even with insurance.

In addition to coinsurance rates, a recent study estimated that even when a non-emergency in-network ambulance ride was arranged in advance, patients could still receive a bill for the full out-of-network portion of the cost, amounting to over $400 on average.

The study also estimated that during emergencies, 72% of patients with private health insurance could receive a surprise bill after their ambulance rides because the ambulance company the 911 dispatcher called was not in-network. 

What to Do When You Get an Ambulance Bill?

Most of the time, ambulance bills will be sent to your insurance company directly, and you will receive documentation from your insurance company rather than the ambulance company itself.

In the case that you were unable to provide your insurance information to the ambulance company, you may receive an ambulance bill in the mail. If this happens to you, contact your insurance company for clarification on how to proceed, as different companies in different states may handle the process differently than others.

If you don’t have insurance and you receive an ambulance bill, there are a few ways you can potentially reduce the bill to make it easier to pay.

  • Ask for an itemized version of the bill to ensure you aren’t getting overcharged for any services.
  • Haggle with the ambulance company if you notice certain services are billed higher than expected. For an understanding of general ambulance costs, see the above section titled “How much is an ambulance ride without insurance?”.
  • If a long period of time has gone by without paying the bill, you may be able to settle with the ambulance company for a lesser amount, either with your own negotiation skills or with the help of a qualified lawyer.

What Is Accident Insurance?

Accident insurance is exactly what it sounds like—insurance that covers you in the case of an accident. An accident can be anything from an unexpected fall to a broken bone.

Accident insurance can help pay for ambulance costs when you find yourself in a situation where you need to use an out-of-network ambulance, or you simply do not have ambulance coverage in the first place. Accident insurance typically pays you a lump sum directly rather than working with ambulance companies to settle the bill.

Accident insurance is an excellent supplementary insurance policy to have alongside a more general health insurance policy if you are an individual who is at high risk of certain accidents that will require ambulance transportation.

Which Insurance Companies Cover Ambulance Rides?

The vast majority of both car and health insurance companies will offer plans that cover ambulance rides. 

When it comes to ambulance rides, rather than focusing on your insurance company, focus on how to pick the right health insurance plan. Be sure you have adequate coverage for ambulance rides if you think there is a chance you will need one in the upcoming year so that you can avoid unwanted billing surprises.

What Do You Do if an Ambulance Company Is Not in Your Insurance Network?

Unfortunately, due to the nature of emergencies, it can sometimes be difficult to coordinate an ambulance pickup from an in-network company. You may be unable to articulate your situation clearly to the 911 dispatcher—or, in worst-case situations, waiting for a covered ambulance ride may pose a significant risk to your health.

One option is to choose a type of health insurance plan that provides partial or full coverage for out-of-network ambulance services. These plans are often more expensive than their more restrictive counterparts, but the savings on even a single ambulance ride can outweigh the increased premium costs and prevent you from experiencing financial hardship due to your ambulance ride.

Can I Choose the Ambulance Company I Want to Use?

If you need to use ambulance services, you have the option of calling an ambulance company directly to arrange a pickup. In this case, you may choose the ambulance company you want to use.

Things are a bit trickier when you call 911 with a medical problem. You may request a specific ambulance company when you call, but depending on the severity of your injury or ambulance availability, the 911 dispatcher may use their discretion and dispatch an out-of-network ambulance to ensure your life is not put in danger by any potential delays.

Summary

Does insurance cover ambulance rides? Most of the time, the answer is yes, but it depends on the exact situation and the type and scope of your insurance policies. 

If you are an individual who is likely to need to use ambulance services in the upcoming year, double check your policy to understand the exact details of your coverage. In particular, look to see when you are covered for ambulance services and if there are any restrictions on ambulance companies that you can or cannot use if you wish to receive coverage.

When selecting a health insurance company for more general ambulance transportation coverage, be sure to work with a trustworthy company that makes it clear what you are and aren’t covered for. Understanding your health insurance plan completely, without needing to sift through the fine print, gives you the best chance of reducing medical expenses in worst-case situations when ambulance transportation is required.

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