Will Medicare Cover Me for an Emergency Operation?

Medicare is health insurance provided by the U.S. government to ensure senior citizens have the health coverage they need. In the case of an emergency, you will want to understand how your Medicare plan will cover you and your costs. It will all depend on if you have Original Medicare, a Medigap, or Medicare Advantage plan. If you wonder if Medicare will cover you for an emergency operation, keep reading to see how each plan will cover you.

Medicare Part A

Medicare Part A provides inpatient hospital coverage. As an inpatient, Part A covers a semi-private room, three meals a day, labs services, and medications administered during your stay. Although Part A covers an inpatient stay at the hospital, if you were to have an emergency operation or a scheduled surgery as an inpatient, the procedure would fall under Medicare Part B, not Part A. Medicare Part A only covers your inpatient room and board.

As an inpatient, you will pay the Part A deductible of $1,556 per 60-day benefit period. After you pay the deductible, Medicare will cover your Medicare-approved services in full for up to 60 days. If your inpatient stay surpasses 60 days, you will pay a daily copayment.

Medicare Part B

All Medicare-approved emergency outpatient surgeries, operations, and procedures fall under Medicare Part B. For example, if you were rushed to the emergency room and needed immediate surgery, your services would fall under Part B. Non-emergency outpatient surgeries and procedures are covered by Part B, as well.

If your services fall under Medicare Part B, you will first pay the annual $233 deductible. After you pay the deductible, you will pay a 20% coinsurance for your outpatient services. The 20% coinsurance could be expensive if you were to have an outpatient surgery. Many beneficiaries purchase either a Medigap or Medicare Advantage plan to help with these out-of-pocket costs.

Medigap plan

Medigap plans cover the gaps that Medicare leaves you, such as the Part A deductible, hospital costs, and coinsurance. Medigap plans work as secondary coverage to Original Medicare. If Medicare pays for a service, then so would a Medigap plan.

There are ten standardized Medigap plans on the market. The two most popular plans are Medigap Plans G, and N. Medigap Plan G covers the Part A deductible, hospital costs, Part B copays, coinsurance, and excess charges. Your only out-of-pocket cost for the year would be the Part B deductible. Now, the difference between Plan G and Plan N is that Plan N does not cover Part B excess charges, and you may pay up to a $20 copay for doctor’s visits and a $50 copay for emergency room visits.

There are also two high-deductible Medigap plans, which are high-deductible Plan F and high-deductible Plan G. To learn more about these plans and their separate deductibles, visit:

Medicare Advantage plan

Medicare Advantage plans work differently than Original Medicare. Medicare Advantage plans have networks, and the private insurance carrier will set the plan’s cost-sharing amount. However, no matter which type of plan you have, HMO or PPO, your plan will cover you in an emergency.

Your Medicare Advantage plan will include a Summary of Benefits packet that will break down the detail of your plan and what your cost-sharing amounts will be for emergency services.

Final point

Medicare Part A covers inpatient services, and outpatient services fall under Part B. If you have a Medigap plan, know that your Medigap plan will pay if Medicare pays first. If you have a Medicare Advantage plan, refer to your plan’s Summary of Benefits to understand your cost-sharing amounts in the case of an emergency.

Emergencies operations are never planned, but you will want to be prepared and understand how your Medicare plan will cover you or a loved one just in case.

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