Medicare covers most hospital-to-hospital transfers, but only if the transfer is medically necessary and follows specific rules
Medicare will pay for a transfer between hospitals if your doctor orders it because your current hospital cannot provide the care you need — for example, you need a higher level of care, a specialist procedure, or equipment the first hospital does not have. The sending hospital arranges the transfer, and Medicare treats it as a continuation of your inpatient stay, so you do not restart your deductible or copay.
The catch is that Medicare only pays if the transfer itself is medically necessary. If you ask to move to a different hospital for comfort, convenience, or because you prefer it, you may be responsible for the cost. The sending hospital's discharge planner should tell you before the transfer whether Medicare will cover it, but this does not always happen clearly, and you should ask directly.
Key Takeaways
- Medicare covers transfers when your doctor orders them because your current hospital lacks the care or equipment you need, and the transfer is arranged by the hospital, not by you.
- Transfers for convenience or personal preference are not covered by Medicare, and you may owe the full cost of transport and the receiving hospital's charges.
- The sending hospital must document the medical reason for the transfer in your chart, and you should ask the discharge planner to confirm Medicare will cover it before you leave.
- If you are transferred to a hospital outside your Medicare network or to a facility that does not accept Medicare, you may face higher out-of-pocket costs even if the transfer was medically necessary.
- Transfers by ambulance are covered under the same rules as the hospital transfer itself — if the transfer is covered, the ambulance ride is too.
How Medicare decides whether a transfer is medically necessary
Medicare's rule is straightforward on paper: the transfer must be ordered by a physician because the sending hospital cannot provide the level of care or specific service you need. In practice, this means your doctor documents in your medical record that you require a higher level of care (such as intensive care), a procedure or specialist the first hospital does not offer, or equipment or technology only available at the receiving hospital.
The sending hospital's utilization review team — the staff who check whether Medicare will pay for your stay — makes the final call. They look at your medical record to confirm the reason for transfer is documented. If it is not clearly written, they may deny the transfer as not medically necessary, and you could be billed.
This is why asking the discharge planner directly is important. Say: "Will Medicare cover my transfer to [hospital name]?" If they say yes, ask them to put that in writing or note it in your discharge paperwork. If they are unsure, ask to speak to the utilization review nurse before you move.
What happens to your hospital bill when you transfer
If Medicare covers the transfer, your original hospital stay and the receiving hospital's stay are treated as one continuous inpatient admission. This means you do not pay a second hospital deductible. Your copay for the entire stay — usually $0 for days 1–60 under Original Medicare — stays the same.
The sending hospital bills Medicare for the days you were there. The receiving hospital bills Medicare for the days you are there. Medicare pays both according to the diagnosis-related group (DRG) system, which means the total payment is based on your condition, not on how many days you spend in each hospital.
If the transfer is not covered by Medicare, you will receive a bill from the sending hospital for the transfer itself and possibly from the receiving hospital for its care. This bill can be substantial — hospital transfers can cost $1,000 to $5,000 or more depending on distance and method of transport — and you would owe it in full.
Transfers within a hospital system versus transfers to a different hospital
Transfers within the same hospital system — for example, from one building to another campus of the same health network — are almost always covered by Medicare because they are considered part of your inpatient stay. You stay under the same admission number, and billing is seamless.
Transfers to a completely different hospital system are more likely to be scrutinized. Medicare will still cover them if medically necessary, but the receiving hospital must accept Medicare, and your doctor's reason for the transfer must be clearly documented. If you are transferred to a hospital outside your Medicare Advantage network, you may face higher copays or coinsurance even if the transfer is covered.
Before any transfer to a different hospital system, confirm with the sending hospital that the receiving hospital accepts Medicare and that your transfer will be in-network (if you have Medicare Advantage). Out-of-network transfers can result in surprise bills.
What you should do before a transfer happens
Ask the discharge planner or your doctor these questions before you are moved:
- Why am I being transferred, and which hospital am I going to?
- Will Medicare cover this transfer?
- Will I owe any out-of-pocket cost for the transfer or the receiving hospital?
- Is the receiving hospital in my insurance network (if you have Medicare Advantage)?
- How will I get there — by ambulance, medical transport, or other means — and who is paying for that?
Write down the answers and ask for them in writing if possible. If the hospital cannot confirm Medicare will cover the transfer, ask to speak to the utilization review team before you leave. Do not assume the transfer is covered just because your doctor ordered it.
Ambulance and medical transport costs during a transfer
If you are transferred by ambulance, Medicare covers the ambulance ride under the same rule as the hospital transfer: if the transfer is medically necessary and covered, the ambulance is covered. You pay nothing for the ambulance if Medicare covers the transfer.
If the transfer is not covered by Medicare, you will be billed for the ambulance separately. Ambulance rides can cost $500 to $2,000 depending on distance and whether it is a basic or advanced life support transport.
If you arrange your own transport — for example, you ask a family member to drive you instead of using an ambulance — Medicare will not reimburse you for mileage or other costs. The hospital may arrange transport as part of the transfer, or you may have to arrange it yourself and pay out of pocket.
What to do if you receive a bill for a transfer Medicare should have covered
If you receive a bill for a hospital transfer you believe Medicare should have covered, do not pay it when ready. First, contact the hospital's billing department and ask why the transfer was not covered. Ask them to review the medical record to confirm whether the transfer was medically necessary.
If the hospital says the transfer was not medically necessary, you have the right to appeal. Ask the hospital for a detailed explanation in writing. Then contact Medicare at 1-800-MEDICARE and ask them to review the denial. You can also file a formal appeal with Medicare, and you have 120 days from the date on the bill to do so.
Keep all paperwork: the discharge summary from the sending hospital, the admission paperwork from the receiving hospital, any bills, and any written communication about why the transfer was or was not covered. This documentation is essential if you need to appeal.
Frequently Asked Questions
Can I refuse a transfer and stay at my current hospital?
Yes. If your doctor recommends a transfer but you want to stay, you can refuse. However, if the hospital determines it cannot safely provide your care, they may discharge you instead. If you refuse a medically necessary transfer and stay, Medicare may not cover your continued stay at that hospital, and you could be billed. Discuss your concerns with your doctor before refusing.
What if I want to transfer to a specific hospital that is farther away?
If your doctor agrees the farther hospital has a service or specialist you need that your current hospital does not have, Medicare will cover the transfer. If you straightforward prefer that hospital for personal reasons, the transfer is not medically necessary, and you will be billed. Your doctor's documentation is what matters.
Do I pay a copay for the receiving hospital if I transfer?
No. If the transfer is covered by Medicare, you do not pay a second hospital copay. Your copay for the entire stay — both hospitals combined — is based on the number of days you spend as an inpatient, not on how many hospitals you visit. You still owe your deductible if you have not met it for the year.
What if the receiving hospital is out of network for my Medicare Advantage plan?
Out-of-network transfers can result in higher copays or coinsurance, even if the transfer is medically necessary. Before the transfer, ask the sending hospital to confirm the receiving hospital is in your plan's network. If it is not, ask your Medicare Advantage plan whether they will cover the out-of-network transfer or if you should be transferred to an in-network hospital instead.
Can I be transferred without my permission?
No. The hospital must tell you about the transfer and why it is happening. You have the right to refuse, though refusing a medically necessary transfer may result in discharge instead. If you are confused or disagree with the transfer, ask to speak to a patient advocate or social worker before you are moved.