Medicare covers emergency room services everywhere in the United States. You will pay a copayment for these services, which are considered outpatient hospital treatment. If you are admitted to the hospital, you or your supplemental insurance must pay for the Part A deductible and coinsurance.
- If you are a member of a Medicare private health plan, such as an HMO, you have a right to receive emergency care anywhere in the United States regardless of whether the hospital or provider is in the plan’s network. You do not need a referral from your primary care doctor first. Even if you receive emergency department services from an out-of-network provider, you cannot be billed more than the lesser of $50 or the in-network cost for emergency services. Your plan must also cover all medically necessary follow-up care relating to the medical emergency if delaying the care would endanger your health. If your plan does not pay for your emergency care, you have the right to appeal.
Medicare, or your Medicare private health plan must cover the emergency services even if your condition, which appeared to be an emergency, turned out not to be an emergency. For example, you had chest pain and thought you were having a heart attack, but at the emergency room the doctors said you just had heartburn.
Even if you do not have any health insurance, you still have the right under federal law to receive medical care in the case of an emergency regardless of your ability to pay.