The AAA successfully secured a 23-month extension of the Medicare ground ambulance add-on payments through the Continuing Appropriations and Extensions Act (H.R. 5371), restoring the payments after their expiration on October 1, 2025. The legislation maintains the current add-on rates of 2% for urban transports, 3% for rural transports, and 22.6% for super rural transports through the end of 2027. On May 7th, 2025, S. 1643, introduced in the Senate, would increase the rates of the add-on payments, including raising the super rural add-on to 26.7%. While the extension provides important stability, Medicare reimbursement rates still fall short of covering the cost of providing ambulance services. The AAA will continue working with Congress to secure long-term payment reform and make these critical add-on payments permanent so ambulance providers can continue delivering vital emergency and non-emergency care to their communities.

In 2018, the AAA led efforts to have Congress direct the Centers for Medicare and Medicaid Services (CMS) to collect operational and financial data from ground ambulance services through a survey. The goal was to use this data to permanently integrate add-on payments into ambulance rates and make data-driven updates to the fee schedule that more adequately support ambulance providers. CMS has since transmitted the raw data to the Medicare Payment Advisory Commission (MedPAC), which will analyze the data and issue recommendations by Summer 2026. We are now nearing a point where reform is within reach, ensuring that data collection continues and ambulance payment extensions are not only maintained but increased.

The American Ambulance Association (AAA) is advocating for the elimination of the federal fuel tax for all ambulance services, including for-profit providers—an exemption currently enjoyed only by nonprofit and municipal EMS agencies. Ambulance providers have faced growing financial pressures since the establishment of the Medicare ambulance fee schedule in 2002, which significantly reduced reimbursement rates and eliminated the ability to adjust rates for rising operating costs, such as fuel. Data from the CMS Ambulance Cost Collection system indicates ongoing shortfalls between reimbursement and the actual cost of providing services.

Medicare Advantage (MA) enrollees often face significantly higher out-of-pocket costs for ground ambulance services than beneficiaries in traditional Medicare. According to a 2025 Health Management Associates white paper, the average MA copayment for a ground ambulance transport is approximately $273, compared with about $100 under traditional Medicare. As MA enrollment continues to grow and now represents more than half of all Medicare beneficiaries, these excessive copayments are creating a substantial financial burden for patients who require emergency medical transportation.

In some cases, MA copayments can equal or even exceed the Medicare allowable amount for the ambulance service itself, leaving patients responsible for unexpectedly high bills during medical emergencies. No one calling 9-1-1 should be forced to worry about unaffordable cost-sharing for medically necessary ambulance care. Ground ambulance services should be afforded the same cost-sharing protections that already apply to other Medicare-covered services, ensuring MA enrollees are not charged more than they would pay under traditional Medicare.