Emergency room visits
Medicare covers emergency care at any hospital that accepts Medicare. You do not need approval first, and you do not need a referral.
| If you are | Part that pays | What you generally owe |
|---|---|---|
| Treated and sent home | Part B (outpatient) | Part B deductible ($283), 20% of doctors' services, and a hospital copay for the ER visit |
| Admitted to the hospital as an inpatient | Part A for the stay; Part B for doctors | Part A deductible ($1,736 per benefit period) and 20% for doctors |
| Kept for observation | Part B (outpatient) | Outpatient costs. See observation status |
A hospital copay for any single outpatient service is limited to the amount of the Part A inpatient deductible.
Urgent care
Urgent care centers are covered under Part B at 20% after the deductible when the center accepts Medicare. They are often less expensive than the ER for non-life-threatening problems, but not every center accepts Medicare, so ask before you go.
Ambulance rides
Part B covers ground ambulance transportation to the nearest appropriate facility when other transportation could endanger your health and the trip is medically necessary. It can cover air ambulance only when ground transport would not be appropriate. You pay 20% after the deductible.
- Non-emergency ambulance trips generally require a doctor's written order showing medical necessity.
- Medicare does not pay for ambulance trips for convenience.
With Medicare Advantage
Advantage plans must cover emergency and urgent care anywhere in the U.S. without prior authorization. Copays are set by the plan and are often listed per ER visit and per ambulance trip. After an emergency, you may need to switch to an in-network provider for follow-up care.
After an emergency
- Save every bill, notice, and your Medicare Summary Notice.
- Ask for an itemized bill and compare it with the notice.
- If a claim is denied, you can appeal. See how to appeal.