The No Surprises Act: what it covers if you have insurance
The No Surprises Act has protected people since January 1, 2022. If you have most kinds of private health insurance, it limits surprise out-of-network bills. If you don't have or don't use insurance, you can usually get a good faith estimate and dispute a bill that is much higher.
Checked against official sources: October 30, 2026.
What is covered and what you pay
- With most private health plans (job-based plans, Marketplace and other individual plans), you are protected from surprise out-of-network bills for emergency care, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.
Law: 42 U.S.C. 300gg-111, 300gg-131, 300gg-132, 300gg-135
- For protected services, you can't be charged more than your in-network cost-sharing (copay, coinsurance, deductible).
Law: 42 U.S.C. 300gg-131, 300gg-132
- A bill for care before you met your deductible is not by itself a violation of the No Surprises Act.
Law: CMS, Dispute a bill
Ground ambulances and plans not covered
- 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
- Short-term limited duration plans, health care sharing ministries and fixed indemnity plans such as hospital indemnity insurance are not covered. Vision-only and dental-only plans generally are not. Medicare, Medicaid, Indian Health Services, VA health care and TRICARE have their own protections.
Law: CMS, Know your rights
Notice and consent
- For some scheduled out-of-network care, a provider may ask you to sign a notice and consent form. Signing it gives up your protections for that care, and signing is your choice. You should not be asked to sign one for emergency care. At an in-network facility, it may never be used for emergency medicine, anesthesiology, pathology, radiology, neonatology, assistant surgeons, hospitalists, intensivists or diagnostic services such as lab work, or when no in-network provider there can give the care.
Law: 45 CFR 149.420(b); CMS, Know your rights
Where to get help
- Call the help desk with questions or to complain if a provider or insurer did not follow these rules. Help is available in English, Spanish and over 350 other languages.
Law: 42 U.S.C. 300gg-111, 300gg-131, 300gg-132, 300gg-135
States with their own ground ambulance protection
Before you act
If you get a bill that may be covered, do not pay it yet. Ask the provider in writing to check it against these rules, keep every statement and envelope, and use the free help desk or your state insurance department to file a complaint.
Quick answers
Does the No Surprises Act cover ground ambulances?
Ground ambulance services are generally not covered by these federal protections, unless a state law has different rules.
What do I pay for out-of-network care it covers?
For protected services, you can't be charged more than your in-network cost-sharing (copay, coinsurance, deductible).
Which plans are not covered?
Short-term limited duration plans, health care sharing ministries and fixed indemnity plans such as hospital indemnity insurance are not covered.
Free help
Free help can look at your bill and your letters. Legal aid groups, state insurance departments and the federal help desk do not charge for this.