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Does your medical coverage include ambulance services? The answer is yes, in most cases, for TRICARE (Prime, Select, US Family Health Plan, Overseas), Medicare, and TRICARE For Life.

What’s Covered

TRICARE covers the following terms of ambulance utilization:

Outpatient Services: Includes emergency transfers to or from your home, an accident scene, or other location to a hospital.

Inpatient Services: Includes transfers from a hospital-based emergency room to a hospital more capable of providing the required care as well as transfers between a hospital or skilled-nursing facility and another hospital-based or free-standing outpatient therapeutic or diagnostic department.

Air or boat ambulance transport is covered when a land vehicle can’t get to you or when great distance or other obstacles are involved in transporting you to the nearest hospital with appropriate facilities. Costs might differ from land ambulance.

Ambulance Copay Comparison by Plan and Status

• Prime Outpatient: $0 active duty, $20 retired.
• Prime Inpatient: 0% active duty, 25% retired.
• Select Outpatient: $79 active duty, $106 retired.
• Select Inpatient: 20% active duty, 25% retired.

[RELATED: MOAA's TRICARE Guide]

What’s Not Covered

TRICARE doesn’t cover:

• Ambulance service you use instead of taxi service when your condition would have permitted use of private transportation.
• Your transport to be closer to your home, family, friends, or personal physician.
• Medicabs or ambicabs that transport you to/from medical appointments.

TRICARE disclaimer: The list of covered services is not all-inclusive. TRICARE covers services that are medically necessary and considered proven. Your ambulance copays will depend on your TRICARE plan.

Medicare Part B covers medically necessary emergency and nonemergency ambulances services at 80% of the Medicare-approved amount. All ambulance companies that contract with Medicare must be participating providers. TRICARE For Life will pay the Medicare deductible (if not already reached that calendar year) and 20% copays on all Medicare-approved ambulance services.

Medicare might cover scheduled/regular nonemergency ambulance transportation with a written order of medical necessity from your doctor at least 60 days prior to the trip. For unscheduled/irregular nonemergency trips, the physician’s written order must be provided within 48 hours after the trip.

[FROM MEDICARE.GOV: Ambulance Service Coverage]

Part B coverage must be within a service area and cover ambulance transportation from and to the following:

• From your home or any other place where need arises to the nearest appropriate hospital or skilled-nursing facility (SNF).
• From a hospital or an SNF to your home if the hospital or SNF is the nearest appropriate facility.
• From an SNF to the nearest medical provider if the SNF cannot provide you with necessary treatment and the cost to transport is less than bringing the treatment to and from you.
• From your home to the nearest appropriate renal dialysis facility and back.