How Does Medicare Cover Emergency Room Services?If you have Original Medicare, Part B covers emergency room services anywhere in the U.S. Emergency room services are typically provided when you have a medical condition that requires immediate action, such as an injury or sudden illness.

Medicare Advantage Plans also must cover emergency room services anywhere in the country. If you have a Medicare Advantage Plan, be aware that if you are receiving emergency or urgently needed services:

  • Your plan cannot require you to see an in-network provider.
  • You do not need a referral.
  • There are limits on how much your plan can bill you if you receive emergency care while out of your plan’s network. Specifically, you will be billed either $50 or your plan’s in-network cost for emergency services, whichever is less.
  • Your plan must cover medically necessary follow-up care related to the medical emergency if delaying care would endanger your health.
  • You have the right to appeal if your plan does not cover your emergency care.

If your condition was not an emergency but appeared to be an emergency at the time, Original Medicare or your Medicare Advantage Plan must still cover your care. For example, let’s say you have chest pain and think you are having a heart attack. If you go to the emergency room and doctors discover that your pain is heartburn, your care should still be covered because the situation appeared to be an emergency. Even if you do not have health insurance or the ability to pay, you still have the right under federal law to receive medical care in the case of an emergency.

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Return to: Medicare In-Depth

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