Medicare can help cover many medical services, including lab testing, doctor’s visits, hospice, and more. However, a lot of people wonder if Medicare coverage applies to emergencies. Health emergencies often come about unexpectedly, and the last thing to worry about is whether Medicare covers you or not. So, are you covered for emergency treatment with Medicare?
Medicare & Emergency Treatment
Medicare does cover emergency services to treat serious injury or illness that is life-threatening or can cause lifelong disability. Whether the treatment will be covered by Part B or Part A depends on your patient status.
If you receive treatment in the emergency room (ER) as an outpatient and are released, Part B will cover your services. Part B will cover 80% of the Medicare-approved costs, leaving you with the remaining 20%.
If you have a Medicare Supplement plan, also known as a Medigap plan, it will help cover some or all the 20% depending on the plan you have. However, keep in mind the annual Part B deductible will apply in this situation, meaning you will need to meet the Part B deductible first before your Medicare benefits kick in. The Part B deductible is $233 in 2022. Additionally, if you are held under observation after you went to the emergency room, you’ll still be covered by Part B.
For example, Medigap Plan G has glowing reviews from many beneficiaries because it covers all the remaining costs after Medicare pays once you meet the Part B deductible.
If you are admitted as an inpatient, Part A will cover your emergency services. However, Part A operates differently than Part B. Part A has a separate deductible for each benefit period you stay in the hospital. In 2022, that deductible is $1,556. Once you meet this deductible and have been in the hospital for more than 60 days, you will begin paying coinsurances.
What happens if you have an Advantage plan? Although Advantage plans operate within specific network areas, they still help cover emergency care. These plans will help cover an emergency visit to an out-of-network emergency room if you need immediate care due to a life-threatening illness or injury. So, if you are experiencing an emergency, your priority should be to find the nearest ER and not determine if you are in-network or not.
Urgent care is also covered by Medicare and is meant for non-life-threatening situations that need medical attention. Like emergency care, Medicare Part B will cover 80% of the approved services you receive. You or your Medigap plan will pay for the remaining 20%. The Part B deductible also applies to urgent care, so you’ll need to meet this amount first.
Advantage plans help cover urgent care as well, even if you are out-of-network. This way, you can get the medical help you need without having to worry about finding an in-network clinic.
Also, keep in mind visiting an urgent care clinic may be more cost-effective than visiting the emergency room, so, if possible, you may consider doing that instead. However, your health is the most critical factor to consider. If you need immediate emergency care, go to the emergency room.
You may be wondering about emergency transportation as well. Fortunately, Medicare Part B can also cover an ambulance ride when medically necessary. If ground transportation cannot get you the immediate help you need, Medicare can also cover air transportation, including a helicopter or an airplane.
It is also possible for Medicare to pay for medically necessary transportation in non-emergency situations. However, you would have to meet specific requirements and obtain a written order from your doctor outlining why the transportation is medically necessary.
Medicare does cover emergency treatment for severe injury or illness that is life-threatening. How you and Medicare will pay for the services depends on various factors, including whether you are an inpatient or an outpatient and more. However, the most important thing to keep in mind is getting the care you need.