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The type of Medicare you have determines how it pays for emergency department services.
Original Medicare covers emergency services under Medicare Part B at any U.S. hospital or medical facility that accepts Medicare. However, that care is subject to a deductible and 20 percent copayment. Supplemental insurance, such as a Medigap policy or a retiree plan from your former employer, may cover these out-of-pocket expenses.
Medicare defines an emergency as an injury, sudden illness or an illness that gets much worse.
If you’re admitted to the same hospital for a related condition within three days, you won’t have to pay the copayment because the visit is considered part of your inpatient hospital stay, covered through Medicare Part A.
Medicare Part B also covers urgent care visits needed to treat a sudden illness or injury that isn’t a medical emergency. Urgent care visits are also subject to a deductible and 20 percent copayment.
How does Medicare Advantage cover emergency services?
Medicare Advantage plans typically have provider networks and generally charge higher copayments and deductibles or don’t cover out-of-network care at all. But the rules are different for emergency services.
In this case, Medicare Advantage plans must cover emergency care as an in-network service, even if the hospital or facility isn’t in the provider’s network. But copayments may be different from under original Medicare.
For example, you may need to pay as much as a $135 copayment for each emergency room visit, whether it’s at an in-network or out-of-network facility. You can compare emergency care copayments for each Medicare Advantage plan in your area using the Medicare Plan Finder. Click on the Plan Details blue button at the bottom of an Advantage plan’s description.
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