Health insurance Medicare Your Coverage Options

Two tips for keeping your emergency care costs down

Written by Diane Archer
There were 451 emergency room visits for every 1,000 people in America in 2014, up more than 10 percent in the last decade. Medicare always covers emergency care. But, the ambulance trip and the emergency room visits can be very expensive if you are not prepared.  Here are two tips to keep your emergency care costs down.
  1. Find a local ambulance that your health plan covers and keep the number in a safe place.
    • If you have traditional Medicare, the government-administered program, find the number for a Medicare-certified ambulance. So long as you have supplemental coverage, your costs should be covered in full.
    • If you are enrolled in a Medicare Advantage plan, a commercial health plan that offers Medicare benefits, or any other commercial health plan, find the number for an in-network ambulance. Otherwise, your costs could be exorbitant. Unless your insurer has negotiated a price with an ambulance company, that company can charge what it pleases. No one controls the price of ground ambulance services. Kaiser Health News reports that patients in commercial health plans are increasingly facing sticker shock from the cost of their ambulance services.
    • If possible, avoid calling 911 for an ambulance because you may have no control over whether your insurer will cover the ambulance services or whether the ambulance will take you to an in-network hospital. Much like surprise medical bills that patients receive from out-of-network doctors who see them when they are admitted to their in-network hospital, bills from ambulance companies that are not part of a health plan’s network can be in the thousands of dollars. A January 2017 Health Affairs study finds that more than 125,000 of 500,000 ambulance trips in 2014 were out of network.
  2. Call your health plan to understand your out-of-pocket costs for emergency room care and what you can do to minimize them.
    • If you have traditional Medicare, Medicare combined with your supplemental coverage should pick up your costs.
    • If you are in a commercial Medicare Advantage plan, administered by a private insurance company, you will be covered for out-of-network care in an emergency for emergency room services. Your health plan cannot bill you more than $50 for those services. Medically necessary follow-up care is also covered when your health is endangered.
    • If you are not yet eligible for Medicare and enrolled in a commercial health plan, you are guaranteed some protections under the law; but, it is best to know your health plan’s rules.

If Congress expanded Medicare to cover everyone in the US, as Senator Bernie Sanders and 15 other Senators have proposed, it would protect everyone from surprise medical bills, including surprise ambulance bills. For now, Representative Lloyd Doggett has introduced a bill that would protect patients from surprise medical bills.

If you want Congress to expand Medicare to everyone in the US, please sign this petition.

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  • Thank you for this website. I am already in deep debt because of my Asthma. I can’t afford a doctor for treatment so I have to be rushed to the hospital by ambulance, or I drive myself which is dangerous when I can’t breath too well. 
    I looked into ACA but I can’t afford it because my SSI is so low & my 401k came too late in my life, and was damaged in the crash.

  • I’m on a Medicare Advantage through United Medicare Complete and I’m on part D. The problem I’ve had is that I’m diabetic and I have 5 stints so because of my health problems I haven’t been able to qualify for other insurance and if I do the cost is so high or there just not interested in taking me, other wise my health is great.

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