In-Network (PPO benefit) - You pay:	Out-of-Network (Non-PPO benefit)* - You pay:
Preventive Care	Nothing for covered preventive screenings, immunizations and services	35% of our allowance†
Physician Care	$25 for primary care $35 for specialists	35% of our allowance†
Virtual Doctor Visits by Teladoc®	$0 for first 2 visits $10 all additional visits	N/A
Urgent Care Center	Accidental Injury: $0 Medical Emergency: $30 copay	Accidental Injury: $0 Medical Emergency: 35% of our allowance†
Prescription Drugs	Preferred Retail Pharmacy: Tier 1 (Generics): $7.50 copay1 Tier 2 (Preferred brand): 30% of our allowance Tier 3 (Non-preferred brand): 50% of our allowance Tier 4 (Preferred specialty): 30% of our allowance Tier 5 (Non-preferred specialty): 30% of our allowance Mail Service Pharmacy: Tier 1 (Generics): $15 copay1 Tier 2 (Preferred brand): $90 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy2: Tier 4 (Preferred specialty): $65 copay Tier 5 (Non-preferred specialty): $85 copay	Retail Pharmacy: 45% of our allowance Mail Service Pharmacy: Not covered Specialty Pharmacy: Not covered
Maternity Care	$0 copay	Pre-/postnatal professional care: 35% of our allowance† Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance Outpatient facility care: 35% of our allowance†
Hospital Care	Inpatient (Precertification is required): $350 per admission Outpatient: 15% of our allowance†	Inpatient (Precertification is required): $450 per admission copay, plus 35% of our allowance Outpatient: 35% of our allowance†
Surgery	15% of our allowance†	35% of our allowance†
ER (accidental injury)	$0 within 72 hours	Nothing for covered services
ER (medical emergency)	15% of our allowance†	15% of our allowance†
Lab work (such as blood tests)	15% of our allowance†	35% of our allowance†
Diagnostic services (such as sleep studies, X-rays, CT scans)	15% of our allowance†	35% of our allowance†
Chiropractic Care	$25 per treatment; up to 12 visits per year	35% of our allowance†; up to 12 visits per year
Dental Care	The difference between the fee schedule amount and the Maximum Allowable Charge (MAC)	35% of our allowance†
Rewards Program	Earn $50 for completing the Blue Health Assessment.3 Earn up to $120 for completing three eligible Online Health Coach goals.3	Earn $50 for completing the Blue Health Assessment.3 Earn up to $120 for completing three eligible Online Health Coach goals.3

Your costs in Original Medicare. You pay a Copayment for each emergency department visit and a copayment for each hospital service. You also pay 20% of the Medicare-approved amount for your doctor's services, and the Part B Deductible applies.

• The emergency room copay is $300 per visit. This copay is in addition to your annual deductible and must be paid even after you have met your annual deductible. The AMP will pay only the maximum allowable charge for covered services and only covered services will apply to the annual deductible. If the third‑party administrator determines that the emergency room visit is an “emergency.
• Emergency Room: $65 copay for Medicare-covered emergency room visits. $25,000 plan coverage limit for emergency services outside the U.S. Ambulance Services: $200 copay for Florida Medicare-covered ambulance benefits. Outpatient Lab/X-Ray.
• A typical co-pay for emergency room services for an insured person is around $250, which may or may not be waived if you are admitted to the hospital. However, with the advent of high-deductible health plans in recent years, even insured persons may have.

Last Updated : 09/20/20183 min read

Anyone might need to go to the emergency room someday. If you have Medicare Part A and Part B, do you know what share of emergency room costs Medicare may cover?

Find affordable Medicare plans in your area

As you may know, emergency room (ER) visits can be expensive. Almost 22% of Americans aged 65 and over had at least one ER visit in 2015, reported the Centers for Disease Control and Prevention (CDC), while one in 10 Americans aged 75 and over had at least two ER visits.

That means that if you’re in the 65-and-over age group, your chances of an emergency room visit are something to consider. And emergency room visit costs are generally higher than a visit to your doctor, reported the U.S. Agency for Healthcare Research and Quality (AHRQ).

Medicare coverage of emergency room costs

If you have a situation such as a heart attack, stroke, or sudden illness, Medicare Part B might cover some of your emergency room costs.

When Medicare covers emergency room (ER) visit costs, you typically pay:

• A copayment for the visit itself
• A copayment for each hospital service you receive there
• A coinsurance amount of 20% for the Medicare-approved cost for doctor services. The Part B deductible applies.

Please note that if you’re admitted to the same hospital as an inpatient for a related condition within three days of your ER visit, you generally don’t pay the ER copayment, because Medicare Part A may cover the ER visit as part of your inpatient care.

Medicare Copay For Emergency Room Visit

Medicare Supplement plans and emergency room costs

You might be able to buy a Medicare Supplement (Medigap) plan from a private insurance company to help pay for some of the Original Medicare out-of-pocket costs mentioned above. Original Medicare refers to Medicare Part A and Part B, and Medicare Supplement plans can work alongside this federal program.

Billing For Emergency Room Visits

In fact, some Medicare Supplement plans may help cover emergency medical care when you’re out of the country (80% of covered services up to plan limits).

If you like your Original Medicare coverage but want to see if you can cover some of the out-of-pocket costs you’re responsible for, you may want to check out which Medicare Supplement (Medigap) plans might be available to you. I can help you with that.

Florida Blue Emergency Room Copay

• Schedule a phone appointment or have me email you Medigap information tailored to your needs; use the links below to set this up.
• Click the Compare Plans or Find Plans buttons on this page to browse Medicare Supplement plans for yourself.