If you have Medicare, the federal health insurance program for people 65 and older or for certain people with disabilities. Medicare covers emergency room visits if a sudden illness or injury causes an emergency. This is true even if you have other health insurance, but your Medicare only covers hospital care. If you have Medicare and another health insurance company, Medicare will not pay for emergency room visits if the cause of your emergency is chronic or routine. Medicare requires you to use your other health insurance for these problems. This sometimes happens with patients with serious injuries or illnesses when no intensive care unit is available in the hospital where they first arrive.
If an ER visit results in a transfer to another hospital, Medicare will reimburse for the initial ER visit and the transfer if you receive emergency services from a doctor that is not an ER doctor. Depending on how your doctor is authorized to provide medical care, Medicare may or may not pay for the service. And if you use an ambulance, Medicare will only reimburse you if your ambulance trip was required by federal or state law.
Does Medicare Part A and B Cover Emergency Room Visits?
According to Clearmatch Medicare Part A will pay for emergency room (ER) visits if you have a sudden illness or injury and you’re admitted to the hospital for treatment. It also pays for urgent care if you go directly from the ER to another hospital’s inpatient department. Medicare Part B will pay for some ER services if your Part A hospital coverage doesn’t cover them. Part A is Hospital Insurance, the major part of the Medicare program. It covers inpatient hospital expenses, skilled nursing facilities, and hospice care. Part B is Medical Insurance, which covers most physician services, outpatient hospital care, medical supplies, and preventive services.
Does Medicare Have a Copay for ER Visits?
Medicare has no general copayment or deductible for hospital or skilled nursing home care. Hospital bills to Medicare beneficiaries often include a facility charge, which covers the care that doctors, nurses, and other hospital staff provide. There may be a separate charge for each doctor who treats you while in the hospital. Sometimes these charges can add up to several thousand dollars. Medicare doesn’t have a copay requirement for ER visits, as it does for doctor’s office visits. Some private health insurance policies require you to pay a percentage of the total bill. In that case, Medicare may still cover most of your ER visit since it might not be a “medical visit” to the doctor’s office. If you have free health insurance from your state or local government, check to see if copay requirements exist. Because ER visits aren’t considered medical visits, they may not count toward your deductible.
What is Medicare Advantage?
Medicare Advantage plans are health insurance plans from private insurance companies. These Medicare Advantage plans are also called “Part C.” Most Medicare beneficiaries have Part A and B, covering hospital and medical care. If you wish to receive your Part A coverage through a Medicare Advantage plan, you’ll have a premium to pay in addition to the premium you would otherwise pay for Part B. Some Medicare Advantage plans charge a monthly premium to what they charge for the policy’s daily rate. You can check with your local Medicare office to see if you are eligible for Medicare Advantage or find out how to enroll.
They give you the same emergency care as traditional Medicare but usually provide more comprehensive benefits, lower premiums, and include coverage for prescription drugs. Part A of Medicare covers inpatient hospital services, such as stays in a hospital or nursing home. Part B covers doctor’s office visits and outpatient hospital services. Both parts have copays and deductibles.
Emergency Room Costs With Medicare Advantage Plan
Medicare Advantage plans have an out-of-pocket limit on what you pay for your covered services. This is a limit set by law each year. Some Medicare Advantage plans may cover doctor visits made within the plan’s service area or outside of it.
They provide coverage for all preventive services, including primary care, without a separate deductible or copayment. You may be required to pay a monthly premium of $50 for emergency services received in the hospital, ambulatory surgery center, or inpatient psychiatric facility. Some people also have coinsurance and other limits that apply to emergency room services received in a hospital outpatient setting. As with any Medicare Advantage plan, the costs you may have out of pocket will depend on your plan. If you’re sick and need to see a doctor, you may be responsible for some or all of the costs.
Emergency Room Costs With Medigap Plan
Medigap is another type of Medicare coverage. It’s available to people with Medicare who want additional coverage for medical services. These plans are jointly managed by the federal government and the states and include Part A and Part B of Medicare. It’s a separate policy from Medicare, so that you will pay a plan premium in addition to your traditional premiums for parts A and B. Health insurance companies make Medigap policies available, which are sold in all 50 states.
If you have a Medicare Supplemental policy called “Medigap,” some insurance companies that provide Medigap policies might pay for some of the costs of your ER visit. But remember that insurance companies have different rules when paying for ER visits. Check with the company that provides your Medigap policy to see if they cover ER visits. In most cases, Medicare will pay all covered costs of an emergency room visit, except the coinsurance amount that applies to these services.
If you have Medicare and are seeking medical assistance for an illness or injury, check with your local hospital to see if they limit the amount of your copayment or deductible in cases of emergency. If a Medicare Advantage plan covers you, that plan may not cover all medical expenses.