How Does Medicare Pay for Emergency Room Visits?
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How Does Medicare Pay for Emergency Room Visits?

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By Daniel Petkevich

Nov 21, 2022

Avoid the stress by knowing how you are covered

The different parts of Medicare can get confusing. Sometimes it might feel like trying to make sense out of alphabet soup. You may remember Part A is considered Hospital insurance, and Part B is considered Medical insurance. But where does an emergency room visit land in terms of your Medicare coverage? The answer is Part B. So how does that affect your cost? Let's talk it through.

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Why not Medicare Part A?

Medicare Part A is your hospital insurance, which helps cover inpatient care you receive in a hospital, nursing facility, or hospice. So if you are in the emergency room, you might then be admitted to the hospital depending on your ailment. If that happens, your coverage will go to Part A, and you won't need to worry about copays for Part B. If you are not admitted to the hospital, your emergency room visit will be covered by Part B.

What is Medicare Part B?

Medicare Part B is your medical insurance, and it helps cover medically necessary doctor visits, preventive care, and other services. This also includes emergency room visits and outpatient care.

That means you will be responsible for the following:

  • ER visit copayment

  • Hospital service copayment

  • 20% of the approved Medicare costs

  • Your Part B deductible of $233 ($226 in 2023)

Medicare Part B covers emergency room visits that are medically necessary. If you have a Medicare Advantage Plan, you will likely have different coverage for emergency room visits. In this post, we'll examine how Medicare pays for emergency room visits and what you can expect if you need to use this benefit.

It's important to check your plan details so you know exactly what the costs will be. If you have a Medicare Supplement Plan G, your out-of-pocket expenses are limited to just the Part B deductible.

What are some things to keep in mind if you need to go to the ER?

If you're in a Medical Emergency and need to go to the ER, remember to call 911 first. Also keep in mind that if you go to a hospital that's out-of-network, you may be responsible for all costs. This is something you don't have to worry about on Medicare Supplement plans. On Medicare Advantage plans, going out-of-network can lead to surprise bills.

Takeaway

An emergency room visit is something no one wants to experience, but ultimately it could be important to have a plan for just in case. Plan to have a potential ER visit billed under Part B, and talk with a Medicare expert at Fair Square Medicare to make sure you aren't caught out with a huge bill. Give us a call at 1-888-376-2028.

Stay up to date on Medicare

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


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