How does Medicare cover emergency room services?

If you have Original Medicare, Part B covers emergency room services anywhere in the United States.  Emergency room services are typically provided when you have a medical condition that requires immediate action, such as an injury or sudden illness. 

Medicare Advantage Plans must also cover emergency room services anywhere in the country, as long as you are receiving emergency or urgently needed services (services that are necessary to evaluate or treat an emergency medical condition or are immediately required as a result of an unforeseen illness, injury or condition).  If you have a Medicare Advantage Plan and receive these services, be aware that:

  1. Your plan cannot require you to see an in-network provider
  2. You do not need a referral
  3. There are limits on how much your plan can bill you if you receive emergency care while out of your plan's network
  4. Your plan must cover medically necessary follow-up care related to the medical emergency if delaying care would endanger your health
  5. You have the right to an appeal if your plan does not cover your care

Can I receive covered emergency services outside the United States?

Original Medicare generally does not cover medical care that you receive while traveling outside the United States and its territories.  There are some exceptions, including if you receive care while traveling from Alaska to another state, or if you are on a cruise ship and receive emergency services while the ship is in U.S. territorial waters. 

Some Medigap (Medicare Supplement) policies provide coverage for travel abroad.  Check with your policy for coverage rules.  Medicare Advantage Plans may also cover emergency care abroad.  Contact your plan for more information about costs and coverage rules. 

Learn more about Medicare Advantage Plans

Learn more about Medicare Supplement Plans

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