Should I buy an ambulance subscription service?

Why buying a subscription might not protect you from ambulance surprise bills.

People fear the high cost of ambulance rides, especially those from out-of-network ambulances. According to the New York Times, ambulances have the highest out-of-network billing rate of any medical specialty. A study published in the April 2020 Health Affairs cites a median cost of $450, but we’ve heard from patients who have faced ambulance bills as high as 6,000.



Although the No Surprises Act prevents 1 million surprise medical bills from anesthesiologists, emergency room doctors, air ambulances,  and many other out-of-network health care providers, the law did not prevent ground ambulances from balance billing. Except for some insured people who live in the 18 states that have passed their own state protections, too many have reason to fear the day a large ambulance bill arrives.

What is an ambulance subscription or membership?

With a fear of these common, hefty ambulance fees in mind, some Americans are signing up for a relatively obscure service that’s been around since the 1940s: ambulance subscriptions. Yes, you can pay monthly or annually for a discount rate on an ambulance. These fees purport to cover potential ambulance co-pays and deductibles or payment plans that match a percentage of out-of-pocket costs.

That makes an ambulance subscription an appealing option in a place such as Richmond, Virginia. The Richmond Ambulance Authority offers a membership-based LifeSaver program, for an annual fee of $62 for individuals or $99 for families. Membership in this program covers co-pays and deductibles remaining after insurance pays its share for emergency ambulance transports. If an insurance company does not cover emergency transport or if the member is uninsured, membership to the LifeSaver program provides a 20 percent discount off the emergency transport bill.

These membership programs are not unique to Richmond. We found “annual memberships” offered in at least two counties in Pennsylvania claiming to pay for anything the patient’s insurance won’t cover. Rural areas have had air ambulance membership programs for years. Ground ambulance subscription programs are often tied to nonprofit, volunteer EMS services rather than privately owned companies. Membership programs are often used to provide additional revenue to EMS services.

Why ambulance memberships may not make sense.

While these memberships may give subscribers peace of mind, once you call 9-1-1, several factors are out of your control. For example, in cities with multiple ground ambulance companies, the ambulance that arrives may not be from the company you subscribe to. Or if a patient travels outside of the area covered by their subscribed ambulance company, that subscription doesn’t cover bills sent by other ambulance companies. Unless a patient can control every aspect of a situation, they can end up out-of-network and outside their subscription or membership.

For some patients, especially those who rarely leave their ambulance’s service area, a subscription service might offer some peace of mind. But at almost $1200 a year, that subscription might not be worth it in the long run.

The better answer is to put an end to ambulance surprise billing, to ease people’s worry about an outsized ambulance bill not covered by their insurer. Our lawmakers need to pass a law to make sure that surprise billing for ground ambulances doesn’t hurt anyone else.

Thanks  to Payton Stredler, University of Virginia, BA 2022, MPP 2023  (Summer 2021 U.S. PIRG Health Care Campaigns Intern) for the underlying research for this article first published in 2021. PHOTO CREDIT: ArtisticOperations from Pixabay


Patricia Kelmar

Senior Director, Health Care Campaigns, U.S. PIRG Education Fund

Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior policy advisor at NJ Health Care Quality Institute, associate state director at AARP New Jersey and consumer advocate at NJPIRG. She was appointed to the Ground Ambulance and Patient Billing Advisory Committee in 2022 and works with patient advocates across the U.S. Patricia enjoys walking along the Potomac River and sharing her love of books with friends and family around the world.