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Does Medicare Cover Emergency Room Visit Costs?

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According to the Centers for Disease Control and Prevention (CDC), there were 136.9 million emergency room visits in 2015. That means more than 43% of people visited an emergency room, according to the CDC.

There are many signs of a medical emergency, according to the U.S. National Library of Medicine. Signs that you might need an emergency room visit include:

  • Breathing problems
  • Unstoppable bleeding
  • Chest pain
  • Sudden severe pain in the abdomen or elsewhere
  • Choking

A drooping face or slurred speech may be a sign of a stroke, and you should seek immediate medical attention, according to the Mayo Clinic.

What to do if you face a medical emergency

If you are facing a medical emergency, get emergency care from the nearest hospital that can help you, recommends the U.S. Centers for Medicare and Medicaid Services. Emergency rooms cannot turn you away based on your health care insurance or not having insurance. Your insurance company also can’t charge you more if you get emergency room care from an out-of-network hospital. This is because of the Emergency Medical Treatment & Labor Act (EMTALA), enacted in 1986, which ensures public access to emergency services regardless of ability to pay.

How Original Medicare covers emergency room costs

Medicare Part B (medical insurance) generally covers emergency room visits. You will be generally covered if you have an injury, a sudden illness, or an illness that quickly gets much worse. If you make an emergency room visit for a non-emergency, you may not be covered. Your emergency room costs under Medicare might include:

  • A copayment for the emergency room visit and a copayment for the hospital services (you might not know this copayment amount until you get the bill)
  • 20% of the Medicare approved amount for doctor visits
  • Your Part B deductible applies

Keep in mind that if you’re admitted to the hospital for the same or related condition within three days of your emergency room visit, your visit will be considered part of your inpatient stay. In this case, you generally won’t have to pay the copayment for the emergency visit.

How Medicare Advantage covers emergency room costs

All Medicare Advantage plans are obligated to pay for emergency room visits. Medicare Advantage plans are required to cover everything that Original Medicare (Part A and Part B) cover but your out-of-pocket costs may differ. A Medicare Advantage may charge you a copayment, for example $80, for every emergency room visit. There may be some stipulations in which you are not required to pay. For example, some plans might stipulate that if you are admitted to the hospital within 24 hours, you do not need to pay your share of the cost for the emergency room visit.

One benefit of a Medicare Advantage plan is that you can generally know your copayment amounts in advance. With Original Medicare, you may not know how much an emergency room visit costs until you get the bill.

Do you have more questions about emergency room visits covered by Medicare? Feel free to enter your zip code on this page to compare Medicare plan options in your location. We can help you find Medicare plan options that address your Medicare needs.

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