If you have Original Medicare, Part B covers emergency room services anywhere in the U.S. Medicare Advantage Plans also must cover emergency room services anywhere in the country. Emergency room services are typically provided when you have a medical condition that requires immediate action, such as an injury or sudden illness.
If you have a Medicare Advantage Plan, be aware that:
- Your plan cannot require you to see an in-network provider.
- You do not need a referral Referrals are authorizations that Medicare Advantage Plans usually require for services not provided by your primary care provider (PCP). For example, Health Maintenance Organizations (HMOs) generally require you to get a referral from your PCP in order to see a specialist or get an eye exam. .
- There are limits on how much your plan can bill you if you receive emergency care while out of your plan’s network A network is a group of doctors, hospitals, and pharmacies that contract with a Medicare Advantage Plan to provide health care services. Generally, plan members will have the lowest costs when using providers and facilities in the plan’s network. Networks may be made up of both preferred and non-preferred providers. , 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, 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.