Q. What does Medicare cover if I have to go to a hospital emergency room when I’m travelling?
A. If you have Original Medicare, Part B covers emergency room (ER) 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. After meeting your deductible, you will be responsible for a 20% coinsurance charge for doctors’ services, as long as your provider accepts assignment (that is, accepts Medicare’s approved amount as full payment for a service). You will also be responsible for copayments for each ER visit and hospital service.
Medicare Advantage Plans must also cover ER services anywhere in the country,as long as you are receiving emergency or urgently needed services — i.e. 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:
* Your plan cannot require you to see an in-network provider
* You do not need a referral
* There are limits on how much your plan can bill you if you receive emergency care while out of your plan’s network
* Your plan must cover medically necessary follow-up care related to the medical emergency if delaying care would endanger your health
* You have the right to an appeal if your plan does not cover your care
Original Medicare generally does not cover medical care that you receive while travelling outside the U.S. and its territories.There are some exceptions, including if you receive care while travelling 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 / supplemental policies provide coverage for travel abroad. Check with your policy for coverage rules. Some Medicare Advantage Plans might also cover emergency care abroad. Contact your plan for more information about its costs and coverage rules.
Q. I have a Medicare Advantage plan and I don’t understand why I was billed so much for using an ambulance recently. I don’t remember paying that much a couple years ago.
Original Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency, in this case, to be any situation when your health is in serious danger and you cannot be transported safely by any other means. If you have a Medicare Advantage Plan, your plan must cover the same services that Original Medicare covers, but can do so with different costs and restrictions. You did not say if you changed from Original Medicare to an Advantage Plan, or maybe you switched from one Advantage Plan to another in the last two years, but both actions could cause your costs to increase from what you remember. Contact your plan directly to learn more about its costs for ambulance transportation. Remember you can change during open enrollment if you decide the plan isn’t working for you.
This information is provided by the Medicare Rights Center, Senior Medicare Patrol, and our State Health Insurance Assistance Program (SHIP). For help understanding Medicare’s coverage rules or appealing a health or drug denial, call 800-803-7174.
Are you turning 65 this year? Are you starting to get a lot of mailings about Medicare coverage and offers from insurance companies? We can help you understand your options!
Region IV Area Agency on Aging and MMAP (Michigan Medicare/Medicaid Assistance Program) will be offering free “New-to-Medicare” classes in the coming months, with the first being Thursday, April 25, from 2 – 4pm at 2920 Lakeview Avenue in St. Joseph. For information on attending, contact Mistelle at 269-408-4354