Does Medicare Cover Visits to the Emergency Room?

An emergency can occur at any moment. That’s why you should know what parts of Medicare cover the emergency room (ER) visits . Let’s take a look at what Part A, Part B, and Medigap policies cover in case of an emergency.

Does Medicare Part A Cover ER Visits? 

Part A is your inpatient hospital coverage. It will help cover a share of the costs from your hospital or ER stay — once you meet your deductible. 

Part A benefits include:

• Hospice
• Limited home health care 
• Inpatient hospital services
• Skilled nursing facility care

Related Post: Home Health Care and Nursing Home Care – What’s the Difference and How Does Medicare Cover Them?

How Much Does Medicare Cover for the ER?

Again, Medicare Part A doesn’t cover ALL of your ER expenses. You’ll need to pay the deductible before your benefits kick in. After meeting your deductible, Part A will cover 100% of the costs — for 60 days. After that 60 days, you’ll pay coinsurance for each day you remain in the hospital. 

Does Medicare Part B Cover ER Visits?

Part B usually covers emergency medical services when you get injured or become suddenly ill, or your illness(es) get much worse in a brief period. It will also cover your doctor’s follow-up appointments after getting treatment from the ER or urgent care center. You’ll be responsible for the 20% coinsurance and Medicare Part B deductible, along with any extra hospital services.

Related Post: Can Recent Immigrants Get Medicare If They’re Over 65?

A Copay for an ER Visit with Medicare

What’s the copay you’ll need to pay out of pocket? It depends on the type of services provided, how much your doctor charges for them, and the kind of facility where the services take place. You probably won’t know the exact amount until you get the hospital bill. 

Note: If you’re admitted to the hospital within three days of your ER visit, that visit will be counted as part of your (inpatient) stay. So, you won’t need to pay the copayment for the ER.

What About Medicare Advantage? 

Because Medicare Advantage plans have to cover the same expenses as Original Medicare, they also pay for emergency room visits. The only difference is your out of pocket costs are not as predictable. And they vary. Advantage plans offer more coverage than Medicare alone, but they don’t give you as many benefits as Medicare Supplement plans.

Do Medicare Supplement Plans Cover ER Visits?

Yes. Medicare Supplement (Medigap) plans cover anything Original Medicare does. These policies fill in the coverage gaps with Medicare. Depending on which plan you pick, your Part A deductible and all cost-sharing could be 100% taken care of — including coverage for any coinsurance for hospital stays beyond 60 days. 

What About Emergencies Outside the U.S.?

You might need emergency care when traveling abroad. But emergency services may only be covered in special circumstances. If you love foreign travel, consider buying a Medigap policy to get coverage for medical services overseas. Often, these policies will give you foreign travel coverage in emergency settings.

The agents at Bobby Brock Insurance can answer all your questions about emergency room coverage and Medicare as a whole. Call (662) 844-3300 or complete an online form to compare rates on all the Medicare options in your area.