Does Medicare Cover Emergency Health Services?

Learn about emergency health services covered by Medicare, including urgent care visits, emergency room coverage, and ambulance service.

Accidents happen when we least expect them, but there are still ways to be prepared. Having comprehensive medical coverage helps minimize the out-of-pocket cost of health emergencies, whether they require a quick urgent care visit or a trip to the emergency room.

If you’re covered by Medicare, there’s a lot you need to know about emergency health services. The following types of care are likely to be necessary at some point in your life. 

Urgent Care Visits

Urgent care centers and walk-in clinics are ideal for minor injuries and illnesses that require prompt treatment, like mild infections, gastrointestinal symptoms, and respiratory symptoms. Medicare covers urgent care visits, but not all urgent care centers will accept Medicare. Double-check this before you seek care. If your condition doesn’t warrant a trip to the ER, it’s worth looking for a provider who will take Medicare.

Any services covered by Medicare will most likely be in either of these categories:

  • Part B: Once you’ve reached the Part B deductible, your medical insurance benefits cover 80% of all urgent care services and tests. A copayment may also be applicable. 
  • Part D: Any medication prescribed for your illness or injury is covered by Part D. 

A supplemental Medigap policy can also help cover out-of-pocket costs related to urgent care visits. 

If you have Medicare Advantage, urgent care treatment is covered. There will typically be a copay or coinsurance.

Emergency Room Coverage

While urgent care centers are prepared to handle a wide range of situations, severe injuries and cardiac and neurological symptoms require more immediate care. Medicare Part A (hospital insurance) only covers the cost of an emergency room visit if you’re admitted to the hospital and treated for the injury or illness that brought you there. 

Fortunately, a visit that isn’t covered by Medicare Part A may be eligible for coverage through Medicare Part B (medical insurance) for ER services or Part D (prescription drug coverage) for any IV medications administered during your visit. Medicare Part C (Medicare Advantage) also pays for ER visits. If you have Medigap to supplement your Original Medicare plan, it will help pay your 20% portion of the associated costs.

Ambulance Service

Depending on your illness or injury, you may require ambulance service to a local hospital. Medicare Part B will pay for ambulance service if your health would be endangered by traveling another way, such as a personal vehicle or public transportation. 

For example, if you’re injured at home, and immediate treatment could save your life, it’s best to call an ambulance. Attempting to get a ride to a hospital will slow you down, increasing the risk of a more serious injury or death. 

It’s important to note that Medicare will only pay for transportation to the nearest facility that can provide the medical care you need. If you choose to visit a hospital that’s farther away, you may be responsible for the difference in the cost of transportation between the two. 

In situations where road travel is not possible, either due to heavy traffic or the distance to the nearest properly equipped hospital, Medicare will also pay for airlift service to avoid any delays that could jeopardize your health.

Medicare Advantage also covers ambulance services with a copay or coinsurance.

Preparing for the Unexpected

No one can predict an emergency, but it is possible to take steps to prepare and protect yourself. If you have questions about using Medicare coverage for emergency health services, reach our licensed advisors at (888) 443-5336 (TTY: 711) or browse our advisor directory to find a professional who serves your state. 

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