While comparing medical and health service insurance options you may wonder, "Does Medicare cover emergency room visits?" The short answer is yes, but the amount covered depends on several factors.
What Emergency Room Visits Are Covered by Medicare Part A?
Medicare coverage is provided for emergency room visits under certain circumstances. This includes (but is not limited to) being admitted for the treatment of an injury, the sudden onset of an illness or an illness that quickly worsens.
Medicare Part A does not cover emergency room visits unless you require hospital admittance. If you receive treatment in an emergency room and don't get admitted, Part A doesn't apply.
What Emergency Room Visits Are Covered by Medicare Part B?
Medicare Part B covers emergency room visits to any emergency room or hospital in the United States, even outside your local area.
Does Medicare Cover Emergency Room Visits in a Foreign Country?
If you travel outside of the United States, check your Medicare coverage carefully before leaving. Not all Medicare plans cover a foreign emergency room visit or hospital services. And those that do often come with restrictions.
How Much of an Emergency Room Visit Is Covered by Medicare?
Does Medicare completely cover emergency room visits? Unfortunately, no.
Expect to pay part of the total cost of each emergency room visit and any hospital services administered during your stay. The amount that you pay is known as a copay.
In addition, you will also pay a portion of the doctor's services charged during your emergency room visit.
Keep in mind that you will first need to pay your Medicare plan's deductible. Once this deductible is met, your plan begins to cover a portion of your emergency room costs.
Medicare Part A will only cover emergency room visits if hospital admittance is required. This means you could expect to cover 100% of the cost for an emergency room visit — including all expenses associated with both doctor and hospital services — if you don't need to be admitted.
Medicare Part B typically covers 80% of charges for doctor services during an emergency room visit. This means you are expected to cover the remaining 20%.
How Much Does an Emergency Room Visit Cost?
The total cost to a patient for an ER visit depends on many factors, including the type of treatment and medical facility, which Medicare plan you have and whether you have supplemental coverage through Medigap or a Medicare Advantage Plan.
Medicare Advantage and Emergency Room Visits Coverage
Medicare Advantage plans can help with emergency room visit coverage. Although Medicare Advantage plans usually operate within provider networks, the law requires they offer coverage equal to or better than the original Medicare plans (Plan A and Plan B). So, if you have a Medicare Advantage plan and require an emergency room visit to a facility outside of your provider network, Medicare will cover a portion of your care.
The amount covered depends on which Medicare Advantage plan you have. Check your plan particulars for how much you would pay for your deductible, copay and coinsurance for emergency room visits.
If you live with a medical condition or are susceptible to illnesses that could require frequent emergency room visits, a Medicare Advantage plan may be the right choice, providing more coverage and flexibility.
No one plans to visit the emergency room. However, understanding your current (or potential) health situation, along with the possible costs associated with an ER visit, can help you make the best Medicare plan choice for your lifestyle — and your wallet.