Confused by Wake County’s EMS subscription flyer? Here’s everything you need to know.

If you live in Wake County, you probably found a blue pamphlet in your mailbox recently that said something to the effect of: “In an emergency, the last thing you should worry about is paying for the ambulance.”

Or maybe you saw a picture of the flyer on Reddit’s r/mildlyinfuriating page along with some angry comments like:

“Now we need insurance to cover the uncovered part of our primary insurance?”

Here’s everything you need to know about why these subscriptions exist and whether they are worth it.

What is an EMS subscription?

If you remember anything from this article it should be this: Even without a subscription, Wake County will still dispatch an ambulance if you call 911.

The subscription, which is only for residents with insurance, simply lets you off the hook for an emergency ambulance ride copay in exchange for an annual $60 fee.

The Wake County service has existed for more than 17 years and covers about 36,000 residents. The subscription covers all insured members of a household and the program runs from Jan. 1 to Dec. 31. So you’ll want to wait a few days: If you sign up before the end of November, your coverage will end on Dec. 31. New subscribers can sign up for 2023 coverage starting Dec. 1.

Several counties in North Carolina, including Johnston County, have similar subscriptions.

Why do EMS subscriptions exist?

Counties need to fund their EMS services somehow.

Many counties, like Baltimore and Montgomery counties in Maryland, rely on taxes. In those areas, residents never have to pay out-of-pocket for public ambulance rides.

But in places where raising taxes is too difficult or the tax base is poor, counties sometimes turn to subscription services to generate funding, said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.

“Taxing power is obviously the most effective way to collect from people,” he said. “That doesn’t exactly play well politically.”

Enter EMS subscriptions.

If enough people chip into the subscription, the program acts as a sort of “voluntary taxation,” he said. Last year, Wake County’s program logged about 19,500 household subscriptions, which translates to about $1,170,000 in revenue.

“I personally find it a somewhat odd way to handle the financing of your ambulance services,” he said.

Brian Brooks, assistant chief for Wake County EMS, said he did not know whether the county profits from the program. Even if they don’t profit, Adler said, the program might be a way for counties to cut losses on unpaid ambulance bills.

“A lot of them eat (the unpaid bills) or don’t fight you that hard on it,” he said.

The fine print

There are many exceptions to the program.

The program doesn’t cover non-emergency ambulance rides (like rides between hospitals for specialty care) or rides to a hospital that is not the “closest appropriate facility.”

Maybe most notably, the subscription does not apply if you ride in an ambulance that isn’t owned by Wake County. A Raleigh couple learned this when they called 911, a Johnston County ambulance arrived, and they were stuck with a $236 copay despite subscribing to the Wake County program.

Despite these exceptions, the subscription might still be worth it, Adler said.

The first thing to consider when weighing whether to sign up for a subscription is how much your insurance provider expects you to pay for an ambulance ride. On average, privately insured people are expected to pay about $250, Adler said.

And the county program covers as many ambulance rides as you need over the course of the year.

Then, consider whether you expect to have a medical emergency in the near future and whether you’d be able to afford a bill for the ambulance ride (in addition to other health care bills).

“If not, then the insurance product can be a useful thing to protect yourself against downside risk,” he said.

Teddy Rosenbluth covers science and health care for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.