Does Humana Cover Ambulance Service?

If you’re wondering, “does Humana cover ambulance service?” The quick answer is yes, but certain conditions apply. Humana includes ambulance service coverage within its health plans, generally adhering to Medicare’s rules.

However, coverage can vary depending on the type of service—emergency or non-emergency—and the specific Humana plan you have.

This article delves into what this coverage entails, including the potential need for prior authorization, cost considerations, and the differences between various Humana plans in 2025.

 

Key Takeaways

  • Humana’s ambulance service coverage, under original Medicare, includes emergency and non-emergency transport with both ground and air ambulances to various medical facilities, requiring prior authorization for non-emergency services.

 

  • Coverage under Humana includes medically necessary transportation to hospitals and skilled nursing facilities; however, it is subject to limitations and exclusions such as compliance with Humana’s billing and reimbursement policies.

 

  • Costs associated with ambulance services for Humana members can vary based on factors like copayments, deductibles, and network providers, with tools available to estimate personal financial responsibilities and differences in coverage options within HMO and PPO plans.

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Understanding Humana’s Ambulance Service Coverage

 

Does Humana Cover Ambulance Service?, Understanding Humana's Ambulance Service Coverage

 

Humana’s ambulance service coverage, an integral part of original Medicare, serves as a lifeline during emergencies and beyond. This comprehensive plan covers transportation to medical facilities and necessitates prior authorization for non-emergency transport.

You might wonder what ‘emergency care’ implies here. In a nutshell, it refers to the care provided by a professional trained for emergencies, without which proper treatment for a medical emergency may not be possible, leading to potential claim denial.

 

Emergency Care Under Humana

Under Humana, emergency care comes into play when a life-threatening illness or injury requires immediate medical attention.

The coverage includes:

  • Medically necessary ambulance services in states like MD, ME, MI, and MN

 

  • Encompassing both air and ground ambulance services

 

 

  • Transportation to a hospital, critical access hospital, or skilled nursing facility

 

Interestingly, ambulance services may still be covered, even if an individual is not admitted to the hospital after an emergency in states like NY, OH, or PA.

 

Transportation to Hospital or Medical Facility

When it comes to transportation to a hospital or medical facility, Humana’s policy is all about ensuring the patient gets the care they need at the nearest appropriate facility.

This could be an array of options such as:

  • Hospitals

 

  • Critical access hospitals

 

  • Skilled nursing facilities

 

  • Doctors’ offices

 

  • Retail clinics

 

  • Urgent care centers

 

  • Specialty hospitals

 

  • Lower cost preferred pharmacies

 

If the patient receives the required care in states like CA, CT, DC, DE.

 

Prior Authorization for Non-Emergency Transport

For non-emergency transport, Humana requires prior authorization. This involves registering with HealthHelp and submitting requests online or via telephone to ensure they pay for the service.

However, failure to obtain this authorization might result in denial of the claim by Medicare, and the ambulance company might seek payment for all incurred charges from you.

Scope of Coverage: What’s Included and What’s Not

 

Does Humana Cover Ambulance Service?, Scope of Coverage: What's Included and What's Not

 

Although comprehensive, understanding what is included and what isn’t in Humana’s ambulance service coverage is important.

Services are deemed medically necessary when the transportation to a hospital, critical access hospital, or skilled nursing facility is required to sustain, restore, or address a diagnosed medical condition.

However, there are exclusions and limitations, including compliance with Humana’s billing and reimbursement policies.

Therefore, comprehending your Humana policy thoroughly can help you navigate these complexities.

 

Medically Necessary Services

Humana considers an ambulance service medically necessary when it’s required for transporting a patient to a hospital, critical access hospital, or skilled nursing facility, in accordance with prevailing healthcare industry norms.

This includes transportation to a hospital, critical access hospital, or skilled nursing facility in nonemergency cases, provided there is a written order from Medicare.

 

Limitations and Exclusions

Humana’s ambulance service coverage is restricted to Medicare Part B coverage, which encompasses ground ambulance transportation to a hospital, critical access hospital, or skilled facility.

In certain instances, Medicare may extend coverage to limited, medically necessary, non-emergency ambulance transportation with a written order from a healthcare provider.

However, out-of-network ambulance services are subject to the maximum allowable fee, which may exceed in-network costs.

 

Understanding Your Policy’s Fine Print

Understanding the fine print of your Humana policy is of utmost importance, as it encompasses the specific terms, limitations, and requirements that dictate the coverage or exclusion of services like ambulance transportation.

This includes policy exclusions, which can have a substantial impact on your ambulance service coverage as they delineate specific situations and services not included in your policy.

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Cost Considerations with Humana

 

Does Humana Cover Ambulance Service?, Cost Considerations with Humana

 

The cost of ambulance services hinges on certain factors – copayments, deductibles, and the choice between in-network and out-of-network providers. It’s key to be mindful of these elements as they can greatly influence your ambulance service bill.

 

Copayment and Deductible Details

The typical copayment for ambulance services under Humana varies depending on the specific plan, although certain copay plans may feature a $0 copayment for ambulance services.

However, the deductible for Part B coverage with Humana is $226 in 2023, and once the deductible is met, individuals usually cover 20% of the Medicare-approved amount for most medical services, including ambulance services.

 

In-Network vs. Out-of-Network Charges

When utilizing Humana, out-of-network ambulance services are subject to the maximum allowable fee, which may exceed in-network costs.

Opting for an out-of-network provider could result in balance billing, wherein the provider invoices you for the portion not covered by your Humana plan, leading to higher expenses compared to in-network services.

 

How to Estimate Your Ambulance Service Bill

To get an estimate of your ambulance service bill, Humana offers a benefit estimator tool. This online platform provides a personalized estimate of your financial responsibility for ambulance services.

The tool considers factors such as co-payments and deductibles in your estimated ambulance service bill, while adhering to the rules of Medicare Part B coverage for ground ambulance transportation and Humana’s own billing requirements and reimbursement policies.

Medicare Advantage HMO PPO Plans and Ambulance Services

 

Does Humana Cover Ambulance Service?, Medicare Advantage HMO PPO Plans and Ambulance Services

 

Medicare Advantage HMO and PPO plans offer different levels of coverage for ambulance services. Both HMO and PPO plans offer coverage for ground ambulance transportation to a hospital, critical access hospital, or skilled nursing facility under Medicare Part B.

However, they differ in terms of network limitations and the expenses associated with these services.

 

Differences in Coverage Between HMO and PPO

Both Humana’s HMO and PPO plans offer coverage for ground ambulance transportation to a hospital, critical access hospital, or skilled nursing facility.

However, Humana’s PPO plans typically provide greater flexibility for utilizing out-of-network ambulance services in comparison to HMO plans, which frequently impose more stringent network restrictions.

 

How to Choose the Right Plan for Your Needs

Evaluating your individual needs and preferences for Humana’s ambulance service coverage may seem overwhelming, but it’s pivotal in selecting the most suitable plan.

When selecting a Humana plan for ambulance services, consider whether the plan provides coverage for supplementary services such as vision, dental, and hearing. Additionally, assess the overall rating and performance of the plan.

Humana offers guidance for selecting the appropriate plan for ambulance services through their Medicare resources.

Rights and Protections for Humana Members

 

Does Humana Cover Ambulance Service?, Rights and Protections for Humana Members

 

As a Humana member, you have certain rights and protections. Humana strictly follows Federal civil rights laws and does not discriminate based on:

  • national origin

 

  • age

 

  • disability

 

  • sex

 

  • marital status

 

  • military or veteran status or religion

 

This commitment ensures equal treatment for all individuals.

The company ensures reasonable access to medically necessary healthcare services and provides transparency in claims payment through its access to services policy.

 

Non-Discrimination and Access to Services

Humana’s policy of non-discrimination guarantees that services covered under this policy are available to individuals without deny, regardless of their national origin, age, disability, sex, marital status, religion, or language.

To guarantee accessibility for all members, Humana offers over-the-phone interpretation in over 150 languages, TTY services, and alternative formats such as braille, large print, audio, DAISY, and screen reader accessible PDF.

 

Language Assistance and Accessibility

Humana offers free language interpreter services to all members and provides multi-language interpreter services at no extra cost to ensure adequate support for non-English speakers.

Humana members can access language assistance services by contacting Customer Care using the number provided on the back of their member ID card.

Additional Resources and Support

Humana provides a range of resources and support for its members. You can contact Humana’s customer support for any inquiries or concerns about your coverage.

They also offer online tools and resources that provide more information and assistance in comprehending ambulance service coverage.

 

Customer Support Contacts

For general inquiries and individual dental and vision plans, you can call Humana at 800-457-4708 (TTY: 711) daily from 8 a.m. to 8 p.m. Eastern time.

For eligibility/benefits and claims inquiries, as well as provider payment integrity (PPI) inquiries, you can call 800-4-HUMANA (800-448-6262). To schedule medical transportation services, you can call 877-564-0571 (TTY: 711).

 

Online Tools and Resources

Humana’s online resources, including their Medicare transportation and ambulance coverage page, provide in-depth information and guidance to help policyholders understand their ambulance service coverage and manage their healthcare effectively.

Humana also offers mobile applications that enable policyholders to conveniently:

  • Oversee their healthcare

 

  • Examine coverage specifics

 

  • Verify claims

 

  • Obtain a digital Humana member ID card

 

This facilitates on-the-go assistance and information retrieval, allowing users to quickly notice important details.

Summary

Understanding the specifics of Humana’s ambulance service coverage can go a long way in making informed decisions about your healthcare. From emergency care to transportation to medical facilities and prior authorization for non-emergency transport, every aspect has its own set of rules and regulations.

It’s crucial to comprehend the fine print of your policy and be aware of the costs involved. Remember, Humana is there to support you every step of the way with its customer service and online resources.

 

Frequently Asked Questions

 

→  Does Medicare Part A cover emergency ambulance service?

Yes, Medicare Part B covers medically necessary emergency ambulance services at 80% of the Medicare-approved amount.

 

→  What are the disadvantages of Humana Gold Plus?

The disadvantages of Humana Gold Plus Medicare include network limitations, prior authorization requirements, plan restrictions, and potential plan changes.

These factors may affect your access to care and coverage options.

 

→  Does Medicaid cover ambulance rides in SC?

Yes, in South Carolina, Medicaid covers ambulance rides when they are medically necessary. Always confirm coverage with your specific Medicaid plan.

 

  How does Humana define a medical emergency?

Humana defines a medical emergency as a life-threatening illness or injury that requires immediate medical attention.

 

 What are the components of Humana’s non-discrimination policy?

Humana’s non-discrimination policy includes protection against discrimination based on  national origin, age, disability, sex, marital status, military or veteran status, or religion.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.