You never know when a medical emergency will arise, but you can be prepared, both for yourself and for a loved one.
Emergency services and urgently needed care
Emergency care is needed to evaluate or treat emergency medical conditions. An emergency medical condition is severe enough that someone with an average knowledge of health and medicine could reasonably expect your health to be in danger if you don’t get medical attention right away. If you’re pregnant, this could also mean that the health of the fetus is in danger. Urgently needed care is immediately required care because of an unexpected illness, injury, or condition, but not as critical as that for emergency care as described above.
Medicare’s coverage of emergency room services
Medicare’s Part B covers emergency room services anywhere in the United States. Emergency room services are typically provided when you have a medical condition that requires immediate action, such as an injury or sudden illness. If your condition was not an emergency but appeared to be an emergency at the time, Medicare will still cover your care. For example, let’s say you have chest pain and think you are having a heart attack. If you go to the emergency room and doctors discover that your pain is heartburn, your care should still be covered because the situation seemed to be an emergency.
When Medicare covers ambulance transportation
Medicare’s Part B covers emergency ambulance services if the ambulance is medically necessary, meaning it’s the only safe way to transport you, and the transportation supplier meets Medicare ambulance requirements. This is true whether the ambulance is on the road or in the air. An air ambulance would be needed when rapid transportation is needed due either to great distance or another obstacle may be involved in getting you to the closest appropriate facility. In rural areas across Alaska, you automatically meet the medical necessity requirement when your doctor or other medical professional determines that air transport is necessary.
To be eligible for coverage of non-emergency ambulance services, you must be bedbound or need essential medical services during your trip that are only available in an ambulance. This could include administration of medications or monitoring of vital functions. However, Medicare does not provide ambulette services, which are non-emergency transportation, by vehicles designed to transport individuals with limited mobility, such as someone in a wheelchair.
Fraud and billing abuse does occur far more often than you might expect. Red flags to watch for include the ambulance company billing for more mileage than the actual distance of the trip. Another instance occurs when you are transported from your house to a non-covered destination, like your doctor’s office or a community health center. I recommend reviewing your Medicare Summary Notice (MSN) which details the services billed, Medicare payments, and out-of-pocket costs. It is not a bill, but a tool to review for errors or fraud.
For any Medicare related questions, please feel free to contact the State of Alaska Medicare Information Office at (800) 478-6065 or (907) 269-3680; our office is also known as the State health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program. If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
