There were 139 million emergency department visits in 2019 alone. Having a medical emergency is a frightening experience. The last thing you want to deal with is wondering if — and how — your health insurance will cover emergency room visits.
Fortunately, if you have Medicare, you have coverage for emergency department visits. There may be out-of-pocket costs, though.
Here’s what you need to know about Medicare coverage for ER visits!
Coverage Under Original Medicare
Original Medicare comprises two parts, Part A and Part B. Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and home health care.
Part B covers more traditional healthcare needs, such as doctor visits. Part B is the portion of your original Medicare portion that applies to emergency care.
What is the cost of ER visits? Under Original Medicare, you’ll pay a copayment. Generally, this is 20% of the cost of the services you receive. If you have a deductible for Part B, you’ll need to meet that before coverage applies.
If your emergency room visit results in you being admitted to the hospital for that condition within three days, the ER stay will be considered part of your inpatient stay. In that case, Medicare Part A will apply.
What About Different Medicare Plans?
If you don’t have original Medicare, you probably have a Medicare Advantage plan. These plans are administered by private insurance companies and have different costs and coverage for those needing ER visits.
Your Medicare Advantage plan might have a set copayment for each emergency room visit instead of using a percentage. This can be helpful because it makes the cost of Medicare for the ER much more predictable.
Depending on your plan, you might also have a deductible that needs to be met. In some plans, this deductible doesn’t apply to emergencies.
Also, some seniors have concerns about medical networks. Many health insurance plans provide coverage even outside the network if it's an emergency. Not all do, however.
Be sure to contact your Medicare Advantage plan provider before something happens to ensure you’ll have the coverage you need.
Getting Help With Copayments and Deductibles
Those with Original Medicare often worry that they won’t afford the 20% copayment they need to pay. With the cost of medical care rising, that’s a genuine concern.
If you’re anxious about being able to pay your portion, you do have options. One choice is to get a Medicare Advantage plan for more predictable cost-sharing. Another option is to get a Medigap plan to help pay copayments and deductibles.
It’s essential to keep in mind that Medigap has a monthly premium. Medicare Advantage also does, but you can often find a plan that charges only your regular Part B premium.
Get the Coverage You Need For Emergency Room Visits and More
The last thing you need to be thinking about during an emergency is your ER visit coverage. Having the right Medicare plan in place will allow you to have confidence in your insurance whenever you need care.
You can find the coverage you need from emergency room visits to seeing the doctor and specialists. We're here for you if you need help getting everything taken care of.
If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.