Ambulance Services

The 2,900 Ambulance services in the US provide ground or air transportation for patients in need of medical care. Companies typically have contracts with communities and government agencies to provide 911 emergency transports. While the majority of services are provided during emergency situations, ambulances may also be used for non-emergency transport.

Dependence on Third Party Reimbursement

Ambulance service companies provide services to patients, but receive the majority of payments from a variety of third parties, including government organizations, insurers, and managed care organizations.

Risk of Malpractice

Because ambulance service providers provide urgent medical care, companies are exposed to the risk of malpractice.

Sep 4, 2026 - Communities Launch Public EMS Services As Other Providers Shut Down

• Ambulance service closures have prompted some jurisdictions to create public ambulance authorities. Five Delaware County, PA, municipalities, for example, have created an Emergency Medical Services Authority. It is expected to be operational in 2027. The Authority cannot levy taxes, however. It is funded by user fees, grants, and insurance reimbursements. The new authority will determine fees by taking the total operating costs, subtracting revenue coming from insurance, and that will be the cost allocated to property owners. The cost would be divided equally across the participating municipalities. It will be its own legal entity with its own finances.
• National ambulance company American Medical Response has begun partnering with Ambulance services on the use of a system through which, if a caller has a nonemergency medical need, the dispatcher gives that person the option to talk with a specially trained nurse about other options. The nurse navigation system is intended to connect nonemergency patients with appropriate care such as telemedicine or an Uber ride to an urgent care clinic instead of an ambulance trip to a hospital. The goal is to ensure that ambulances are available for critical emergencies. The caller can say no and ask for an ambulance, in which case emergency responders can be dispatched. A nurse may also determine if a higher level of care is needed.
• The Trump administration’s proposed new rules for Affordable Care Act (ACA) plans would shift more health care costs to Americans in 2027, according to The New York Times. Any transportation by ambulance must be covered under the ACA, but ambulance services may be negatively impacted if patients refuse services because they cancelled their insurance policies due to affordability issues. The plans would have much higher deductibles that could lead to larger medical bills. People who rely on the Affordable Care Act for their health insurance coverage could choose plans with much lower monthly premiums under the proposal but that could leave them exposed to medical expenses totaling thousands of dollars more than current ACA plans do before their insurance would kick in, according to The New York Times. The proposal would allow one kind of health plan to raise the annual deductible to more than $15,000 for an individual and $31,000 for a family. The individual deductible would be eight times the average for someone with employer-provided insurance.
• Ambulance service industry employment and average wages for nonsupervisory employees increased slightly during the first seven months of 2026, according to the US Bureau of Labor Statistics. Ambulance service industry sales are forecast to increase at a 5.69% compounded annual rate from 2026 to 2030, faster than the growth of the overall economy, according to Inforum and the Interindustry Economic Research Fund, Inc.

Industry size & Structure

The average ambulance service provider operates out of one to two locations, employs 60 workers, and generates $8 million annually.

• The ambulance service industry consists of about 2,900 companies that employ about 174,300 workers and generate $23.4 billion annually.
• The industry is concentrated at the top (the top 4 firms account for about 35% of industry sales) and fragmented at the bottom.
• Large companies include AMR, Acadian Ambulance Service, and Air Methods.
• Some ambulance service providers operate regionally, and most serve a limited geographical market.