Ambulance Services
This content is for informational purposes only. For medical advice or diagnosis, consult a healthcare professional. In case of an emergency, immediately call 911.
Ambulance services provide emergency transportation to a hospital or skilled nursing facility when a patient’s health condition is in serious danger and safe transportation by other means is not possible. This service ensures that individuals receive immediate medical attention and stabilization while en route to a healthcare facility.
Emergency Medical Condition Definition
An Emergency Medical Condition is defined as “An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.” (healthcare.gov). This is determined based on the Prudent Layperson Standard, meaning a situation that any person with average health knowledge would reasonably consider an emergency.
Specifically, ambulance services are reserved for life-threatening or severe conditions—such as chest pain or difficulty breathing—where the patient’s state makes it unsafe to transport them by a standard vehicle.
Coverage & Benefits
Medicare Part B
- Coverage: Covers ambulance costs when the service is medically necessary.
- Limited Coverage for Non-Emergency Transport: Medicare may provide limited coverage for non-emergency ambulance transportation if a doctor provides a written order stating it is medically necessary (e.g., for End-Stage Renal Disease patients requiring dialysis transport).
- If non-emergency transport occurs multiple times within 30 days, prior authorization from Medicare may be required starting with the 4th trip.
- Facility Limits: Medicare only covers transportation to the nearest appropriate facility capable of providing required care. If a patient requests transportation to a more distant facility, they must pay the additional costs.
- Air Transportation: Emergency transportation by airplane or helicopter is covered only if the location is inaccessible by ground or if medical obstacles, such as long distances or heavy traffic, prevent rapid access to care.
- Patient Cost: After meeting the deductible, the patient is responsible for 20% of the Medicare-approved amount. The Part B coinsurance may be covered through a Medigap plan.
Medicare Advantage (Part C)
- Coverage: Like Original Medicare, Medicare Advantage covers ground and air ambulance services when medically necessary in an emergency.
- Non-Emergency Transport: Coverage requires a physician’s order and prior authorization from the insurer. Some plans may also include a Non-Emergency Medical Transportation (NEMT) benefit for routine medical appointments.
- Facility Limits: Coverage is limited to the nearest appropriate facility. Using an out-of-network provider or a more distant facility may result in higher out-of-pocket costs.
- Air Transportation: Covered only when ground transport is not feasible or when a delay would put the patient’s life at risk. Higher cost-sharing may apply compared to ground ambulance.
- Patient Cost: Plans often charge a fixed copay instead of the 20% coinsurance, and costs count toward the plan’s annual out-of-pocket maximum.
Medicaid (NJ FamilyCare)
- Coverage: Ground and air ambulance services are covered when immediate medical help is required. Prior authorization is not required for emergency transport.
- Non-Emergency Medical Transportation (NEMT): NEMT is available for individuals who lack a working vehicle, do not have a driver’s license, or have a physical or mental disability preventing them from traveling alone. In New Jersey, NEMT is coordinated through Modivcare (phone: 1-866-527-9933; tripcare.modivcare.com). Rides for medical appointments must generally be scheduled at least two to three days in advance.
Private Insurance
- Coverage: Services are covered when immediate medical help is required.
- In-Network vs. Out-of-Network: Patients are responsible for paying the deductibles and co-payments as defined by their specific insurance plan. In New Jersey, Patient Cost for ambulance services in an emergency are adjusted to in-network rates even when the service is provided by an out-of-network provider. Note that in-network protections for ambulance services may vary by state.
- Prior Authorization: While not required for emergencies, prior authorization from the insurer may be necessary for non-emergency inter-facility transfers (e.g., moving from a hospital to a specialized rehabilitation center).
* In-Network refers to hospitals, physicians, and providers (including doctors, nurse practitioners, and physical therapists) who have a contracted agreement with your insurance plan.
* Out-of-Network providers do not have a contract with your insurer, which can result in significantly higher out-of-pocket costs.
Cost Sharing per Coverage Type (2026)
Hospitals and Providers Search
Ambulance Service Providers in Bergen County
The following are non-emergency contacts. In case of an emergency, immediately call 911.
Resources
