Understanding Ambulance Coverage With Humana Medicare Advantage

how much is an ambulance ride with humana ma

Ambulance rides can be extremely expensive, often costing hundreds or thousands of dollars, even with insurance. The average cost of an ambulance ride in the US rose to $1,277 between 2017 and 2020 before insurance or discounts, according to a report from Fair Health. Humana Medicare Advantage plans offer benefits beyond what Original Medicare covers, so it is worth exploring the plans available in your area to see if ambulance rides are covered.

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Medicare Part B covers ground ambulance transportation

Medicare Part B may also cover non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is medically necessary. For example, if you have end-stage renal disease, you may need medically necessary ambulance transportation to a kidney dialysis facility.

Medicare Part B will not cover non-emergency ambulance transportation if you are simply confined to your bed and unable to get up without help. To be eligible for non-emergency ambulance transportation coverage, you must need vital medical services during your trip that are only available in an ambulance, such as the administration of medications or monitoring of vital functions.

Medicare Part B will only cover ambulance services to the nearest appropriate medical facility that is able to provide the care you need. If you request to be transported to a facility that is farther away, Medicare will only cover the cost of the distance between your pickup point and the closest facility available.

If you have a sudden, serious medical emergency, such as shock or heavy bleeding, and ground transportation is not fast enough, Medicare Part B might cover the cost of an air ambulance, either a plane or a helicopter.

Medicare Part B covers 80% of the cost of ambulance transportation after you meet the Part B deductible. You will be responsible for the remaining 20% of the cost.

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Non-emergency ambulance rides

Non-emergency ambulance transportation is usually covered by Humana Medicare Advantage if you have a written order from your doctor stating that ambulance transportation is medically necessary. For example, if you have end-stage renal disease (ESRD), you may need a medically necessary ambulance transport to a dialysis facility.

Medicare Part B also may pay for nonemergency ambulance services with a written order from your doctor attesting that transport is medically necessary. This could include situations where you have restricted mobility and need to get to kidney dialysis.

The cost of non-emergency ambulance rides varies depending on several factors, including the base rate or pickup fee, mileage, the level of support required (basic or advanced life support), oxygen and medical supplies used, and specialty care transport.

The base rate for an ambulance service is typically a fixed fee, regardless of the distance traveled. It covers the costs of having personnel and ambulances available to respond to calls. The base rate can range from $400 to $1,200 or more.

Mileage fees are usually charged per mile and can range from $10 to $30 per mile. These fees compensate for fuel, vehicle maintenance, and depreciation. For example, a 20-mile ride could incur a $200-$600 mileage charge.

Advanced Life Support (ALS) is more expensive than Basic Life Support (BLS) as it requires more advanced training and equipment. BLS, also called "first-step treatment," can be provided by a paramedic or emergency medical technician (EMT) and is suitable for patients who do not need cardiac monitoring or respiratory interventions. ALS includes more invasive procedures and requires a higher level of training for the paramedic.

If the patient requires oxygen, bandages, IV fluids, or medications, these will be added to the cost of the ambulance ride.

Specialty Care Transport (SCT) is required for critically ill or injured patients who need a higher level of care during transport, such as that provided by a nurse or paramedic with extended skills.

The total cost of a non-emergency ambulance ride will depend on how far the ambulance travels and the type of services the individual receives. A standard trip without insurance typically ranges from $1,100 to $1,500, but with insurance, the cost will depend on your specific plan and coverage.

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Ambulance rides without insurance

Ambulance rides can be extremely expensive, even with insurance. Without insurance, you are likely to be charged the full amount, which can range from a few hundred to several thousand dollars. The average cost of an ambulance ride without insurance is $2125, but this can vary widely depending on various factors.

The cost of an ambulance ride depends on several factors, including:

  • The distance travelled (mileage)
  • The level of care and services provided (e.g. basic or advanced life support)
  • Whether you received any medical supplies (e.g. oxygen, bandages, IV fluids)
  • Whether the ambulance company chooses to "balance bill" you
  • Whether the ambulance is from a for-profit or non-profit organisation
  • The number and type of services performed by EMTs, firefighters or paramedics

In the United States, ambulance rides are not protected under the No Surprises Act, which means there are no federal rules governing how you can be charged. This can lead to surprise bills, which are still a risk for those using ground ambulances.

If you receive a large bill that you cannot pay, you can contact the ambulance company to ask about financial assistance or payment plans. You can also try negotiating the bill to reduce the amount.

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Factors affecting the cost of an ambulance ride

The cost of an ambulance ride can vary depending on several factors. Here are some key factors that can affect the cost:

  • Distance travelled: The further the ambulance has to travel, the higher the cost. Ambulance services typically charge a per-mile fee, which can range from $10 to $30 per mile.
  • Type of ambulance service: The cost of an ambulance ride can vary depending on whether it is a private ambulance service or a government/fire service. Private companies tend to charge more than government or fire services.
  • Level of care: The level of care provided during the ambulance ride also affects the cost. Basic life support (BLS) is generally cheaper than advanced life support (ALS), which requires more specialized equipment and training.
  • Medical supplies: The cost of any medical supplies used during the ambulance ride, such as oxygen, bandages, IV fluids, or medications, will be added to the final bill.
  • Number of medical personnel: If multiple emergency medical technicians (EMTs), firefighters, or paramedics are involved in providing care during the ambulance ride, this can increase the cost.
  • Insurance coverage: Whether the individual has health insurance and if the ambulance service is in their insurance plan's network can significantly impact the cost. Out-of-network charges can result in surprise medical bills.
  • Ownership of the ambulance: The cost can also depend on whether the ambulance is operated by a for-profit company, a non-profit organization, or a government agency. Private companies, especially in urban areas, tend to charge higher rates.
  • Emergency vs. non-emergency: The cost of an ambulance ride may be higher if it is deemed an emergency, as this often requires more urgent and specialized care.

These factors can greatly influence the cost of an ambulance ride, which can range from a few hundred to several thousand dollars. It is important for individuals to understand these factors to avoid unexpected expenses and plan for potential emergency situations.

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Humana Medicare Advantage plans

One of the key advantages of Humana Medicare Advantage is its extensive coverage. All 2024 Humana Medicare Advantage plans include routine dental, vision, and hearing benefits, which are not provided by Original Medicare. Additionally, these plans may offer extra benefits such as insulin savings programs, over-the-counter allowances, SilverSneakers fitness programs, meal delivery services, and transportation assistance.

The cost structure of Humana Medicare Advantage plans is designed to provide financial peace of mind. These plans have an annual maximum out-of-pocket cost limit, ensuring that you won't have to worry about unexpected expenses. After reaching this maximum, you pay nothing for covered services for the rest of the plan year.

To summarize, Humana Medicare Advantage plans offer enhanced benefits, nationwide availability, and financial protection. With their range of plan options and additional services, Humana Medicare Advantage plans provide older adults with comprehensive support for their healthcare needs.

If you are considering a Humana Medicare Advantage plan, it is essential to explore the specific plans available in your area and review their benefits to find the best option for your needs.

Frequently asked questions

The cost of an ambulance ride depends on several factors, such as insurance coverage, the type of ambulance service, the distance traveled, and the level of care needed. Humana Medicare Advantage plans offer benefits beyond what Original Medicare covers, so it's important to check your specific plan for details on ambulance coverage.

Humana MA may cover ambulance transportation when you need to go to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and when transportation in any other vehicle could endanger your health. It's important to check your specific plan and contact Humana for more information.

Depending on your location and situation, alternatives to ambulance transportation include public transportation, rideshare services, local taxi companies, community and volunteer transportation programs, and getting a ride from a friend or family member.

To schedule an ambulance ride or get more information about transportation options with Humana MA, contact ModivCare at 866-779-0565 (TTY: 711) or your local Humana plan number. It is recommended to call at least 24 hours before your doctor's visit.

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