Does Medicare cover an ambulance, ferry or airlift from the islands?

What Medicare covers

Medicare Part B covers ambulance transportation when traveling in any other vehicle could endanger your health and you need medically necessary care at a hospital, critical access hospital, rural emergency hospital or skilled nursing facility. Medicare covers the trip only to the nearest appropriate facility that can give you the care you need. CMS's coverage manual counts both land and water transport as "ground" ambulance, so a medically necessary boat transport can be covered the same way.

Air ambulance is a separate category. CMS says a helicopter or airplane may be necessary when your condition requires rapid transport to a treatment facility and great distances or other obstacles prevent rapid delivery by ground, or when you can't be reached by a ground or water ambulance. For people on the San Juan Islands and other places without a road to the mainland, waiting for a scheduled ferry can be exactly that kind of obstacle in a true emergency, but Medicare decides each claim on the medical facts.

What you pay

• Original Medicare: 20% of the Medicare-approved amount after the Part B deductible. Ambulance suppliers must accept assignment, so for a covered trip they can't bill you above that.
• Medigap: pays some or all of the Part B coinsurance, depending on the plan.
• Medicare Advantage: plans must cover emergency ambulance services; cost sharing and any prior-authorization rules for non-emergency transport vary by plan. Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
• Non-emergency trips: Medicare may cover a scheduled ambulance if a doctor's written order says it's medically necessary, such as for some dialysis patients. If the ambulance company thinks Medicare may not pay for a non-emergency trip, it must give you an Advance Beneficiary Notice first.

Air ambulance membership programs are sold separately and aren't part of Medicare. Read what they cover before you buy one, and remember that a covered Medicare trip already limits what you owe.

Ferries and getting to appointments

Medicare doesn't pay ferry fares, gas or other ordinary travel to medical appointments. Two Washington programs can help:

• Washington State Ferries Medical Preferential Load Program. If waiting at the terminal would create a health risk, your licensed provider (such as an MD, RN or PA) can certify you online. When sailings are full, you go on the next available sailing in one standard-size vehicle. On the Anacortes and San Juan Islands route you must arrive 30 minutes before the sailing; on other routes, at least 20 minutes. It isn't for making appointments on time when waiting wouldn't harm your health.
• Apple Health non-emergency transportation. If you have Apple Health with a transportation benefit and no other way to get to a covered appointment, your county's transportation broker can arrange rides, which can include ferry tickets. Call the broker 7 to 14 days ahead when you can.

Telehealth can also save a crossing for some visits; see telehealth and rural Medicare and San Juan Islands ferry health care.

Get help

If you live on an island, check which mainland hospitals and specialists a plan's network includes before you choose. A licensed insurance agent with Benefits Life can compare plans from the companies they work with for your ZIP code, at no cost to you: (206) SENIORS (206-736-4677), TTY 711. For an ambulance claim dispute, see Medicare appeals.

Related questions

Sources

• Medicare.gov — Ambulance services
• CMS — Medicare Benefit Policy Manual, Chapter 10: Ambulance services (air ambulance criteria; "ground" includes water; mandatory assignment)
• WSDOT — Washington State Ferries medical preferential loading
• Washington State Health Care Authority — Transportation services (nonemergency)

Frequently asked questions

What do I pay for a covered ambulance?

After the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount under Original Medicare. Ambulance companies must accept Medicare's approved amount, so they can't bill you more than your deductible and coinsurance for a covered trip. A Medigap policy can pay that coinsurance.

When will Medicare pay for a helicopter or plane?

When your condition needs immediate, rapid transport that ground transportation can't provide, for example because of great distances or other obstacles, or because you can't be reached by a ground or water ambulance. Medicare pays to the nearest hospital that can give you the care you need. If Medicare finds a ground or water ambulance would have been appropriate, it may pay only that amount.

Does Medicare pay the ferry fare for my appointments on the mainland?

No. Medicare doesn't cover ordinary transportation to appointments. If you have Apple Health with the transportation benefit, the regional transportation broker can arrange rides, including ferry tickets, when you have no other way to get to a covered appointment.

Can I get priority boarding on the ferry for medical reasons?

Washington State Ferries has a Medical Preferential Load Program for people whose health would be at risk from a long wait at the terminal. Your licensed health care provider must certify you online in advance. It isn't for getting to routine appointments on time.

Medicare in your Washington county

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