Ground ambulance bills by state
The federal No Surprises Act does not cover ground ambulances. These states have their own rules.
| State | State protection | What the state rule says |
|---|---|---|
Yes | Starting October 1, 2026, an emergency medical service provider, in network or out of network, may not bill you or try to collect anything for covered ground ambulance services except your in-network copay, coinsurance and deductible, and the plan's payment is payment in full. | |
No state limit listed | — | |
No state limit listed | — | |
Yes | If your plan is covered, the insurer must pay an in-network or out-of-network ground ambulance provider at the rate set or contracted with the local government, or if there is none, at the lesser of 325% of the Medicare Arkansas rural ambulance rate or the provider's billed charges (since July 1, 2025). | |
Yes | If your state-regulated plan covers the ride, an out-of-network ground ambulance can charge you only your in-network cost sharing (plans issued or renewed on or after January 1, 2024). If you are uninsured or self-pay, a ground ambulance may not charge you more than the Medi-Cal or Medicare fee-for-service rate, whichever is greater. | |
Yes | If you have a state-regulated plan and a private ambulance company that has no contract with your plan takes you by emergency ambulance, you owe only your in-network deductible, coinsurance or copay; the plan pays the company a set rate. | |
No state limit listed | — | |
Yes | State-regulated health plans must pay a volunteer ambulance company's charge for each ambulance run and basic life support services directly to the company (disputes go to arbitration by the Insurance Commissioner). You still pay your plan's deductibles and copays. | |
No state limit listed | — | |
Yes | If you are in a Florida HMO, the HMO must cover emergency care, including prehospital transport, without prior authorization, and when the HMO is responsible for paying for a covered service, the provider (including an out-of-network ambulance) may not bill or try to collect from you for it, other than your HMO copayment. | |
— | — | |
Not confirmed | — | |
No state limit listed | — | |
Yes | Starting January 1, 2027, if you have state-regulated health insurance, plans must cover emergency and urgent ground ambulance services, and you pay no more out of pocket for an out-of-network ground ambulance than for an in-network one. | |
Yes | If your state-regulated health plan pays an out-of-network ground ambulance the amount Indiana law sets (the lowest of the local government's rate, 400% of the Medicare rate, or the ambulance's billed charge), that payment is payment in full. | |
No state limit listed | — | |
No state limit listed | — | |
No state limit listed | — | |
Yes | If your state-regulated plan covers an emergency ground ambulance ride (not an air ambulance) from an out-of-network provider, the plan's payment is payment in full except your copay, coinsurance and deductible, and those may not be more than your in-network amounts. | |
Yes | If you have a state-regulated plan, ambulance services that are covered emergency services count as emergency services: you pay only your in-network cost sharing and the out-of-network ambulance provider may not bill you more. | |
Yes | If you have a state-regulated plan, your insurer must pay a public, volunteer or county-contracted ambulance service directly (for insurers other than HMOs, when the ambulance gets an assignment of benefits). The ambulance service then may not bill you for covered services beyond your copay, deductible or coinsurance, and may not sue you for money the plan owes. | |
No state limit listed | — | |
No state limit listed | — | |
No state limit listed | — | |
Yes | Under health insurance policies regulated by Mississippi, a payment by your plan to an out-of-network ambulance provider is payment in full for covered services, except for your copay, coinsurance, deductible and other cost sharing. | |
No state limit listed | — | |
No state limit listed | — | |
No state limit listed | — | |
No state limit listed | — | |
New Hampshire Not covered yet: 603 Legal Aid · LawHelp.org · No Surprises Help Desk (CMS) 1-800-985-3059 | — | — |
No state limit listed | — | |
No state limit listed | — | |
Yes | If you have a state-regulated plan with comprehensive coverage, it must cover emergency ground ambulance services, its payment is payment in full, and the ambulance service may bill you only the copay, coinsurance or deductible under your policy. | |
No state limit listed | — | |
Yes | A licensed basic or advanced life support ground ambulance service may not bill or collect from a covered person more than the deductible, coinsurance, copay or other cost sharing the person would owe to an in-network ambulance. | |
Yes | If you have a state-regulated plan, an out-of-network ambulance in Ohio that gives you emergency services may not bill you for the difference between the plan's payment and its charge, and your plan may not charge you more cost sharing than in network. | |
Yes | Since January 1, 2025, if your plan covers the ride, an out-of-network ground ambulance may not bill you more than your plan's cost sharing, and your copay, coinsurance and deductible may not be higher than for an in-network ambulance. | |
Yes | For state-regulated plans issued, renewed or extended on or after January 1, 2026, a ground ambulance may not bill you for a covered ride once you have paid your plan's in-network cost sharing. Your plan must pay the ambulance the local rate set by the city or county, or at least 325% of the Medicare rate if there is none. | |
No state limit listed | — | |
No state limit listed | — | |
No state limit listed | — | |
No state limit listed | — | |
— | — | |
Yes | If you have a state-regulated plan, an out-of-network ground ambulance (not an air ambulance) may bill you only your copay, coinsurance and deductible. Your plan pays the ambulance the rate set by the local government where the service started or, if none was filed, the lesser of the billed charge or 325% of Medicare. | |
Yes | A ground ambulance or paramedic provider may not charge more than the state's base rate for the type of transport plus the state mileage rate, and may not balance bill you. If you have insurance, it may bill you only your plan's cost sharing, a service your plan does not cover, or, if your plan allows less than the base rate plus mileage, the difference up to that total. | |
No state limit listed | — | |
No state limit listed | — | |
Yes | For state-regulated plans issued or renewed on or after January 1, 2025, an out-of-network ground ambulance may not bill you more than your in-network cost sharing for a covered ride. The insurer pays the ambulance directly. | |
Yes | For state-regulated health insurance policies issued on or after January 1, 2027, an out-of-network ground emergency medical services agency is paid directly by your insurer at 200% of the Medicare rate or its billed charges, whichever is less, and that payment is payment in full. | |
Wisconsin Not covered yet: Wisconsin Office of the Commissioner of Insurance (OCI) · Legal Action of Wisconsin · LawHelp.org · No Surprises Help Desk (CMS) 1-800-985-3059 | — | — |
No state limit listed | — |
Ground ambulance services are generally not covered by these federal protections, unless a state law has different rules.
Law: CMS, Know your rights when using insurance