It is no secret that the American health-care system is exorbitantly priced. As a result, a slew of private insurance companies have sprung up to cover American citizens' medical bills. But what if they have a medical emergency and need to travel to another state or to a completely different country for treatment? You've purchased Medicare insurance and are wondering if it will cover the cost of your medical repatriation/evacuation? Are there any constraints and limitations to your insurance plan? This section of Medical Air Service is dedicated to Medicare, the health insurance program for those over the age of 65.
Medicare, a simple explanation
Medicare is a health care insurance program for Americans over the age of 65 that was established in 1965. As the most common type of insurance for American seniors, it provides them with a way to have their health needs met after they leave the workforce. However, besides people who are 65 or older, Medicare is also open to:
- Certain younger people with disabilities; and
Patients with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare's fundamentals include both federal government-provided plans and plans available through private insurers. As further explained, different types of plans can cover different aspects of your health care.
65 or more, why would you require an air ambulance service?
There are several scenarios in which you might need a medical flight. If you have a hip fracture as a result of a serious fall at home or are injured in a car crash, you may need to be rushed to an emergency room. Other examples of emergencies include:
- When skilled medical treatment is needed during transport.
Because air ambulance medical evacuation is an expensive service, you may be wondering if your Medicare coverage includes medical flights. To answer this question, let us look at the various plans it offers.
Understanding Medicare coverage plans
They are divided into four sections, which are labelled alphabetically from Part A to Part D:
- Part A (Hospital Insurance): it covers hospice care, care in a skilled nursing facility, inpatient hospital stays, and some home health care;
- Part B (Medical Insurance): it covers outpatient care, doctors’ and preventive services, as well as medical supplies;
- Part C (Medicare Advantage): it is a form of voluntary enrolment in a private insurance;
- Part D (prescription drug coverage): it helps cover the cost of prescription drugs, including recommended vaccines/shots.
Let us concentrate on the specifics of Plan B for the purposes of this article!
How does Medicare Plan B work?
Plan B is part of what is known as Original Medicare. Subscribers pay for services as they are delivered. To put it another way, they pay a deductible at the start of each year, and also usually 20% of the cost of the Medicare-approved service, known as coinsurance. There is always the option of adding a separate drug plan (Plan D) for drug coverage.
Original Medicare covers a large portion of the cost of covered health care services and supplies, but not all of them. To make up for this, a Medicare Supplement Insurance (Medigap) policy can assist in paying some of the remaining health care costs, such as deductibles, coinsurance, and co-payments. Some Medigap policies also cover services that Original Medicare does not, such as emergency medical care when traveling outside the United States for medical purposes.
Furthermore, when you enroll in Medicare, you will be given another medical coverage option. It is referred to as Medicare Advantage. It is a Medicare-approved private company plan that includes Part A, Part B, and, in most cases, Part D. These bundled plans may provide additional benefits that Original Medicare does not cover, such as vision, hearing, and dental care. It is critical to emphasise that each Medicare Advantage Plan has different rules governing the services received, and may charge different out-of-pocket costs.
Medicare enrolment and eligibility
Medicare Part B is not available to everyone. Others may be able to obtain it by paying a premium. Using the Medicare.gov Eligibility Tool, you can determine if you are eligible for Medicare and how much your expected premium would be.
Does Medicare cover air ambulance transportation?
As a general rule, Medicare strongly favours land ambulances, this service’s costs being substantially lower. However, in some cases, Medicare Part B as well as Medicare Advantage (Plan C) will pay for air ambulance transportation by airplane or helicopter.
For this purpose, the service must be medically necessary, which means that you require immediate and rapid ambulance transportation that a ground ambulance cannot provide. An example of medical necessity might be if you need a specialised, complex, and time-critical surgery.
If your current hospital lacks the necessary equipment or surgical staff, Medicare would most likely approve an air ambulance to transport you to a hospital that could perform the surgery. On the other hand, in most cases where there is no imminent danger of death, Medicare will most likely deny coverage for an air ambulance.
More specifically, the medical flight must be required for one of the following reasons:
- A ground ambulance cannot reach your pick-up location; or
- There is a significant distance to travel by ground or obstacles, like heavy traffic, could prevent you from reaching the nearest health care facility.
Be cautious: Medical necessity can look very different to a doctor than it does to Medicare.
As can be read on the Medicare internet platform, you automatically meet the medical necessity requirement in rural areas, if:
- “A doctor or other medical professional determines that air transport is necessary due to time and/or geographical factors; and
- The air transport meets Medicare-approved air ambulance requirements.”
How much do you pay for an emergency air ambulance transportation?
Depending on the terms and conditions of your Medicare Advantage plan, the rules and options available to you will differ. If you have Original Medicare, Medicare Part B will typically cover 80% of the cost of your air ambulance ride. After you have met your Part B deductible, which in 2022 is $233 per year, you will typically pay the 20% co-payment.
Are there any other limitations on your Medicare coverage?
In life-threatening situations, such as when on-site medical personnel believe your life is in danger, Medicare will almost certainly cover at least some of the costs of an air ambulance. However, this coverage is contingent on pre-approval.
To begin, a doctor must recommend the air ambulance service as a medical necessity. He or a medical facility must then contact Medicare to request authorization for the medical flight. Medicare will cover a portion of the cost if approval is given. You will, however, be liable for the remainder, and your deductible will apply.
Medicare also limits the distance that can be covered by an air ambulance. In an emergency, for example, it is only permitted to transport you to the nearest hospital that can provide the necessary care.
What about non-emergency air ambulance service?
Non-emergency air ambulance transportation may be covered by Medicare if it is required to treat or diagnose your medical condition and any other mode of transportation would jeopardise your health. This may also be true if your doctor issues a written order stating that the air ambulance transportation is necessary due to your unstable medical condition and is needed to transport you to a hospital or other covered health care facility.
Does Medicare cover international air ambulance services?
Medicare does not typically cover care received outside of the United States, including air ambulance services. It will cover international medical care in only a few scenarios. These include emergencies near the U.S. border, where the nearest hospital is in another country. This can also include medical emergencies on cruise ships or while traveling between the continental United States and Alaska.
Advice: If you intend to travel outside the United States, you should consider purchasing travel insurance.
How do you find out if Medicare paid for your ambulance service?
Every three months, you should receive a "Medicare Summary Notice'' (MSN) in the mail, which lists all of the services billed to Medicare, including ambulance services. You can also check your Medicare claims or view your electronic MSNs by logging into your online Medicare account. Your MSN will explain why Medicare did not cover your ambulance ride.
Did you know that? You can appeal Medicare's decision if you believe your medical flight should be covered.
What if Medicare does not cover your medical flight?
Medical Air Service provides a wide range of aeromedical services. We arrange for your medical repatriation, which entails transporting you from your current hospital to a medical facility in your home country. We also arrange for your medical evacuation to the nearest hospital or clinic, especially if the care available at the health facility where you are located is insufficient to treat you. But that isn't all. We also offer a medical escort if you are able to travel on a commercial flight, as well as ground ambulances that transport you from the hospital to the plane and back again.
In any case, it is worth noting that Medical Air Service will transport you whether you are insured or not. There are numerous ways to save money by traveling abroad to receive appropriate, complex, or less expensive medical care. This can be accomplished by taking a scheduled flight if your health permits, and by requesting the services of one of our medical escorts. Also, do not overlook the value of supplementing your Medicare plan with another private insurance. Travel insurance is also a good idea to help offset the costs of your medical transfer. Finally, consider crowdfunding as a last resort. You might be surprised by how generous people are on the internet.
Do you have any further questions?
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Our call center is open 24 hours a day, seven days a week. Please contact us right away for more information on the cost of your medical repatriation or to schedule an air ambulance flight: