How Much Does an Ambulance Cost? 2026 Rates and State Laws

An ambulance ride in the US costs at least a few hundred dollars, and what you end up paying depends on your insurance and on whether the ambulance company is in your plan’s network. Medicare’s 2026 base rate for a basic emergency trip is $455, plus $9.15 a mile. For people with job-based insurance, the average ground trip cost $1,093 in 2021, according to the Health Care Cost Institute (opens in a new tab).

Ground ambulances are also left out of the federal law against surprise medical bills. Nearly half the states have laws of their own, and the table below shows which ones, as of October 2026.

How much does an ambulance cost?

Medicare’s rates are the clearest benchmark, because Medicare publishes them. In 2026, a basic emergency trip has a national base rate of $455, an advanced one $541 to $783, and each mile adds $9.15. Medicare adjusts those for local costs, and private insurance usually pays more than Medicare does.

These come from the CMS ambulance fee schedule (opens in a new tab) for 2026, before Medicare adjusts each rate for local costs and adds its urban or rural bonus. In urban areas, a basic emergency trip ranges from $418.56 to $608.09, depending on where you are.

Private insurance pays more. The Health Care Cost Institute found that for people with job-based coverage, the average price of a ground ambulance trip rose from $820 in 2012 to $1,093 in 2021, and their average out-of-pocket cost from $140 to $229. A helicopter trip averaged $30,151, and an airplane $37,944.

How much does an ambulance cost with insurance?

If the ambulance company is in your plan’s network, you pay your plan’s copay, coinsurance or deductible, and nothing more. If it’s out of network, it can bill you for the difference between its charge and what your plan paid, unless your state forbids it. That happens a lot. In 2018, 51% of emergency ground ambulance rides had an out-of-network charge.

That figure comes from a Peterson-KFF analysis (opens in a new tab) of large employer plans, which also found it for 39% of non-emergency rides. In an emergency, you don’t pick the ambulance. The one that’s sent is the one that takes you, whatever network it’s in.

Why doesn’t the No Surprises Act cover ground ambulances?

Congress left them out when it passed the law in 2020, and set up an advisory committee to study the problem instead. The committee reported in 2024 and recommended a federal ban on surprise bills for emergency ground ambulance trips, with a cap on what patients pay. As of October 2026, Congress hasn’t passed one.

CMS’s page on your billing rights (opens in a new tab) says ground ambulance services aren’t covered by the law’s protections. The advisory committee’s report (opens in a new tab) also proposed a minimum payment for out-of-network ambulances, based on state law or a local government rate where one exists. Until Congress acts, protection depends on your state.

Which states protect you from surprise ambulance bills?

As of October 2026, 23 states do. The newest is Alabama (opens in a new tab), whose law took effect on October 1, 2026. Georgia’s law (opens in a new tab) makes it 24 on January 1, 2027, the count on the Commonwealth Fund’s tracker (opens in a new tab), built with Georgetown University. In these states, an out-of-network ambulance can’t bill you for more than your in-network share, at least for emergency trips.

These laws only reach health plans the state regulates. A self-funded plan, where the employer pays claims itself, follows federal law instead, and 67% of workers with job-based coverage were in one in 2025, according to KFF (opens in a new tab). Oregon and Washington let those plans opt in. Your plan documents or your HR department can tell you which kind you have.

On January 1, 2027, Illinois widens its law to every plan the state regulates and to non-emergency trips, and Georgia’s law starts. West Virginia’s law (opens in a new tab) also widens that day, from HMO plans to every plan issued from then on. Texas’s and Utah’s laws end in 2027 unless their legislatures extend them, as Texas has done before.

You’ll see other counts elsewhere. CMS’s own guide to ground ambulance bills (opens in a new tab) still says 10 states, a figure from 2021. We list each law, so you can check your own state.

How much does an ambulance cost with Medicare or Medicaid?

With Medicare Part B, you pay 20% of the Medicare-approved amount after the $283 yearly deductible, as long as the trip was medically necessary and went to the nearest suitable facility. With Medicaid, an ambulance company that takes Medicaid has to accept its payment, plus any copay your state charges, as payment in full.

Take a 10-mile basic emergency trip in a city with average costs. Medicare’s rate there is $464.40, plus 10 miles at $9.33, for a total of $557.70. Once you’ve met the deductible, your 20% is $111.54. Medicare’s coverage page (opens in a new tab) lists the conditions, and the 2026 deductible (opens in a new tab) is set by CMS each year. The Medicaid rule is in the federal regulations (opens in a new tab).

What about air ambulances?

Air ambulances are covered by the No Surprises Act. If your plan covers air ambulance flights, an out-of-network company can’t bill you more than your in-network cost sharing for an emergency flight, according to CMS (opens in a new tab). An average helicopter trip cost $30,151 in 2021.

A plan can still deny a flight it decides wasn’t medically necessary. If that happens, you can appeal, the same as for any other denied claim.

What can you do about an ambulance bill?

Don’t pay the first bill that arrives until you know what you owe. Wait for your plan’s explanation of benefits, check whether your state protects you, then appeal or negotiate what’s left. CMS’s guide (opens in a new tab) also suggests asking for a reduction or a payment plan, and getting help from your state.

1. Wait for your plan to process the claim. Your explanation of benefits shows what the plan paid and what it says you owe.
2. Ask for an itemized bill. Check the level of care billed, basic or advanced, and the number of miles.
3. Check the table above. If your state protects you and your plan is state-regulated, tell the ambulance company you owe only your in-network share. If it keeps billing you, contact your state’s insurance department.
4. Appeal a denial. If your plan says the trip wasn’t medically necessary, the denial letter tells you how to appeal.
5. Negotiate what’s left. Ask for a discount, especially if you can pay at once, or a payment plan with no interest.
6. Get free help. If your state has a consumer assistance program for health insurance, it can help with an appeal. The No Surprises Help Desk (1-800-985-3059) takes questions about air ambulance bills.

Saving for the part insurance doesn’t pay

Even with good insurance, an ambulance can leave you a bill of a few hundred dollars, which is what an emergency fund is for. If you’re starting one, our guide to average savings by age shows where most people your age are.

Lodavo is a free prize-linked savings app that makes building that fund more fun. It’s coming to the US, and you can join the waitlist below.

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This is general information, not legal advice. State ambulance laws change often, so check with your state’s insurance department before you rely on a rule here.