Medicare coverage in the Emergency Room is necessary because emergencies can happen at any time. If they do, it’s extremely important to know if your after-hours visit has coverage through your Medicare plan.
Let’s take a dive into what Part A, Part B, and Medigap plans cover in the event of an emergency. We will also go over the primary differences between emergency rooms and urgent care centers.
Does Medicare Cover Emergency Room Visits
Depending on the Medicare parts & supplemental policy, the out of pocket expenses vary.
Part A Coverage – What’s Covered?
Part A will help cover a portion of the costs from your emergency room or hospital stay, once your deductible has been met. As of 2020, the Part A deductible is $1,420, for each benefit period.
Part A coverage includes:
- Inpatient hospital services
- Skilled nursing facility services
- Limited home health care
If you paid the necessary Medicare taxes while working, Part A is usually free of premiums.
Part B Coverage – What’s Covered
Urgent Care vs Emergency Room Medicare Coverage
How do you determine whether you should visit an emergency room or the urgent care clinic down the road?
There are a few different factors to consider, such as the severity of your medical emergency, the cost and the time spent at each care facility.
Emergency Room Visits Have Coverage Under Part B
This will also cover your physician follow-up appointments after receiving treatment from the emergency room or urgent care center.
Individuals with Part B have coverage for trips to a hospital emergency room. You’ll be responsible for your copay for the emergency visit and copays for additional hospital services.
You’ll be responsible to pay 20% of the amount for physician services and Part B deductible.
Remember that Part B is an optional plan. If you do choose to enroll in Part B, you also must enroll in Part A. Unlike Part A, you’ll have to pay a monthly premium when enrolled in Part B.
The typical Part B premium for 2020 is $144.60 each month.
Emergency rooms are designed to treat serious, life-threatening injuries and illnesses. It’s open to the public every single day, day or night, rain or shine.
If you’re admitted to the hospital, then you become inpatient and the services will fall under Part A. Once inpatient, you’ll be responsible for Part A costs.
The ER consists of nursing staff, physicians, specialists. It has a huge selection of medical-grade equipment to conduct tests, labs, scans, surgeries, etc.
With the readily available staff and machinery, the ER can come with a larger price tag for services. Sometimes significantly larger than its little brother, Urgent Care.
Look below at some situations that may require a trip to the emergency room:
- Automobile accidents
- Severe falls
- Severe bleeding
- Allergic reactions
- Possible signs of a stroke or heart attack
- Head injuries
Using the Urgent Care Center
Urgent care facilities are fantastic when it comes to treating non-life-threatening injuries and illnesses. Coughs, stitches, sprains, are all great reasons to utilize your local urgent care. They tend to have great hours in comparison to your physician’s office and are typically open earlier, and close later.
Urgent care trips fall under Part B. If you carry a Medigap plan, this will pick up any additional costs.
For example, if you have already met your Part B deductible and you carry a supplemental Plan G, you’ll pay nothing out of pocket.
You’ll find that most facilities accept Medicare. If the facility takes Medicare, they accept Medigap plans.
Quite possibly save hundreds of dollars by choosing to go to urgent care rather than an emergency room.
You may even find that your visit can be significantly shorter than a trip to the ER. This is because the ER deals with so many life-threatening situations that are treated before other patients are seen.
Here are some great examples of situations that would warrant an urgent care visit:
- Ear infections
- School and sports physicals
How Medigap Plans Can Help Out of Pocket Costs
You may find yourself in need of emergency services when outside of the United States. It’s important to know that this may only be covered in unique circumstances.
If you love traveling abroad, this is where the purchase of a Medigap policy would be extremely beneficial. Medigap plans can offer coverage for medical services outside of the United States. Many times, these plans will provide foreign travel coverage in emergency situations.
If you need any additional assistance, please contact one of our Medicare experts at the phone number listed above, or feel free to complete an online rate form.