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Guest column by Martha Jones Sichko

Hearing ambulance sirens or medical ambulance helicopter rotors over Fountain Lake is unnerving, as it signals someone needs urgent medical attention. Perhaps the last thing these patients think of is the cost of their transport, yet these costs can be overwhelming. For a senior on Medicare, knowing the price of emergency or non-emergency transport before a health event happens can prevent a surprise bill. Here’s insight into these costs:

Emergency transport: Original Medicare (Under Part B) covers 80% of the cost of emergency ground ambulance transportation after the $226 Part B deductible is met, when traveling in any other vehicle could endanger a senior’s health, and they need medically necessary services from an emergency room (ER), a hospital, a skilled nursing facility, or a therapeutic site. Original Medicare will only cover ambulance services to the nearest appropriate medical facility that can provide the necessary care.

If the senior has a traditional Medicare supplement plan, the remainder filters to their plan, and—in many cases—it is covered in full.

If the senior has Medicare Advantage (Part C) from an insurance company, their emergency ambulance costs may differ from Original Medicare. The best tip is to call their Medicare Advantage insurance company (on back of card) and document the cost before an emergency occurs.

Medicare Advantage costs for an emergency ambulance stem from a pre-determined co-pay or coinsurance rather than costs based on an “in” or “out” of the network. Strong Medicare Advantage plans have the same co-pay, whether air or ground transportation. The weaker ones usually have a percentage for the ambulance bill or assess higher costs for an air ambulance.

For example: In contacting BCBS to understand their emergency ambulance costs per their Medicare Advantage plans in Freeborn County, they stated the member would have a $315 co-pay for their core plan, a $200 co-pay for their choice plan, and a $50 co-pay for the complete plan.

Non-emergency transport: When transport from home or ER to a care facility is deemed “non-emergency,” cost becomes a more complicated question. With Medicare Advantage, call your insurer and ask how emergency and non-emergency transportation costs differ. Knowing the restrictions and procedures that fall under this covered service is important.

For those with Original Medicare, there are some cases in which it will pay for limited, medically necessary, non-emergency ambulance transportation when a person has a written order from a doctor stating that ambulance transportation is necessary.

If original Medicare approves the doctor’s order for the non-emergency ambulance transportation, then the costs are the same as an emergency ambulance as described above, but checking with your plan is always a sound idea. According to the Minnesota Department of Health’s Senior Linkage line, if a person chooses not to go to the nearest appropriate medical facility, Original Medicare will not pay.

The bottom line, ask the physician or care facility to certify the medical necessity of non-emergency transportation.

Emergency and non-emergency transportation costs can be confusing. For personal support and questions, call Senior Linkage at 800-333-2433 or Center for Medicare and Medicaid Services (CMS) at 888-524-9900. To understand Medicare and the different plans and services available in 2023, visit: www.mnhealthcarechoices.com.

Martha Jones Sichko is a senior advocate, helping to ensure affordable, accessible healthcare in Freeborn County