Emergency services these are covered inpatient and outpatient services you receive from a qualified provider. An emergency medical condition has symptoms that are severe enough that someone with an average knowledge of health and medicine could reasonably expect your health to be in serious danger if you do not get medical attention right away.
An emergency medical condition can result in:
- Serious danger to your health, or if you are pregnant, the health of your unborn child
- Serious damage to bodily functions, parts, or organs
Urgently needed services are covered services that:
- Are not emergency services as defined above, but are medically necessary and immediately required as a result of an unforeseen illness, injury, or condition
- You receive when you are temporarily outside of your Medicare Advantage Plan’s service area or when you are in the service area but the network is temporarily unavailable or inaccessible, and
- Given the situation, it is not reasonable for you to wait to get the needed services from your regular plan provider after you return to the service area, or when the network becomes available
These definitions are important if you have a Medicare Advantage Plan, because there are certain protections you have if you need emergency or urgent care outside of your plan’s network (read: What if I receive emergency or urgently needed services from an out-of-network provider?).
If you have Original Medicare, you can receive emergency or urgently needed services from any provider who accepts Medicare throughout the U.S., and there are some protections that exist if you see an opt-out provider (read: What if I receive emergency or urgently needed services from an opt-out provider?).
YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.
This content was created and copyrighted by the Medicare Rights Center ©2020. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.