Due to the high and often unexpected costs of health care today, Americans are becoming more hesitant to receive certain critical healthcare services. 

We often run across retirees on Medicare who are avoiding a visit to the doctor, or those that are unwilling to undergo recommended tests or surgeries. 

During a health care emergency, the last thought on your mind should be, “How am I to pay for this?”, especially in time of emergency when an ambulance ride is required. 

I’ll briefly describe what wording to look for in Medicare Advantage plans to potentially seek out (and those to possibly avoid) to ensure you have the right Medicare Advantage coverage for an ambulance ride.

There are 2 main types of ambulance types:
      1.  Ground Ambulance
      2.  Air Ambulance (e.g. helicopter, Life Flight)

The average cost without insurance for a ground ambulance ride will vary on the geography and critical care needed, but it can range from $900 to $1,300+.  We have one client that claims that they were charged over $4,000 for a 5-minute ambulance ride! 

Most of us don’t ever expect to be in a bad car accident or to have a heart attack, but it’s critical to understand how your insurance works in case an ambulance is needed.

In our experience, we have seen air ambulance flights to range from $60,000 – $80,000+.  If one doesn’t have health insurance, a bill of that magnitude could be financially devastating. 

Even with Original Medicare, 20% would be on your shoulders.  This would mean your coinsurance could easily be over $12,000 even before arriving at the hospital. 

This is not exactly what one would expect with Medicare, but it’s the reality unless you have a Medicare Supplement or Medicare Advantage plan to cap your risks.

Coverage varies by Medicare Advantage plan, but there is a high likelihood that your Medicare Advantage plan will require a coinsurance payment for ambulance rides.  Here are a handful of quick tips to ensure you have the right ambulance coverage:

• Be certain that your Medicare Advantage plan benefit covers both Ground and Air ambulances.
• Oftentimes you may see a fixed dollar amount for ground ambulance (e.g., $250), but the air ambulance is 20% coinsurance, which would be the equivalent to what Original Medicare would cover. This would force you to quickly hit your out-of-pocket maximum for the calendar year even before arriving at the hospital.
• Some insurance companies are not forthright about the coverage for air ambulances. If this is the case you will need to explore the Evidence of Coverage (EOC) for that plan.  These can be 350-400+ pages long!

Note that there are two private investment companies that own a significant portion of the US ambulance service sector.  Surprise!

During a 5-year period the average ambulance cost increased by 60%.  One never knows when they or a loved one are going to need critical life saving ground or air ambulance transportation.  Even though we may not need an ambulance ride today, we have Medicare insurance in case that day does come.

One of our clients is a snowbird and was in good health, but while on winter vacation they had a heart attack and had to be air lifted to the nearest hospital.  Some of our clients have required several ambulance rides during a given year. 

Since ambulance companies might be out of network, be sure to understand what your copays and coinsurance would be for in and out of network ambulance services. We often recommend looking for plans with set copayment for ground and air ambulance services for both in and out of network, when possible.

Medicare is extremely complex and confusing!  Reach out using any of the following to see how we can of help in your specific situation:

info@superiorfinancialgrp.com
www.retirementbenefitpros.com

 

Photo by Victor Amenze