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In Queensland and Tasmania, ambulance fees and charges for residents are covered entirely by the state governments.
Most other states and territories have made ambulance services free for pensioners or pension concession card holders.
SA pensioners, on the other hand, are able to apply in writing to access concessions when their bills arrive. Anecdotal evidence shows some pensioners preferring to call cabs, or put off seeking emergency medical help, rather than foot the expense of an ambulance callout.
"We really think it's time the state government stepped up and levelled the playing field," COTA SA chief executive Miranda Starke said.
"Cost of living is going up, rent is going up, mortgages are going up and more older people are retiring with a mortgage than ever before.
"Something has got to give."
Ms Starke said there was "plenty" of data to show scrapping fees had no impact on ambulance usage.
She said the triage system meant that one in three calls for help resulted in a call-out.
"We understand on the face of it, it sounds like a really scary, big proposition," she said.
"In the same way that we don't ask people to pay for the police to come and help them in an emergency, ambulance is something that many older people rely on as an essential service."