There may be no other type of health care where insurance coverage is more critical than emergency room visits. After all, you’re less likely to be thinking about costs and coverage in the event of an emergency, when receiving quick care is top of mind.
Fortunately for Medicaid beneficiaries, Medicaid covers emergency room visits.
Each state has two sets of Medicaid benefits: those that are required by the federal government to be offered (mandatory) and those that the state chooses to offer on its own (optional). Emergency room care is a mandatory benefit that Medicaid covers in every state.
Join our email series to receive your free Medicare guide and the latest information about Medicare and Medicare Advantage.
By clicking "Sign me up!” you are agreeing to receive emails from MedicareAdvantage.com.
Although every state is required to provide Medicaid coverage of emergency room visits, the way this care is covered can vary by state.
We recommend that you contact your state Medicaid program for more information about how your emergency room visit may be covered by your state’s Medicaid program.
Emergencies can happen anytime, including when you’re visiting another state.
There are four instances in which a state Medicaid program must provide coverage and care to a beneficiary who lives in another state.
If one of the above criteria applies to your emergency room visit, you will likely receive Medicaid coverage for the care. It should be noted that states have some broad flexibility in how they determine out-of-state payment rates.
Whether or not Medicaid will cover care received at an urgent care clinic or other walk-in clinic will depend on the type of care you receive and the state you live in.
For example, clinic services are an optional benefit that is left up to each state to cover at their own discretion, but physician services are a required benefit in every state. Your coverage may depend on whether the care you receive is considered a clinic service or a physician service.
Rural health clinic services and federally qualified health center services are both required benefits in every state, so if your urgent care visit falls under either category, it would be covered by Medicaid.
Most urgent care facilities in the U.S. accept Medicaid, but it’s always a good idea to ask prior to receiving any billable services.
Some Medicaid beneficiaries are also eligible for Medicare. Some “dual-eligible” beneficiaries may be able to enroll in a certain type of Medicare Advantage plan called a Dual-eligible Special Needs Plan, or D-SNP.
These plans are designed specifically for those who are eligible for both Medicare and Medicaid, and they can include additional benefits that are not traditionally offered by either Medicare or Medicaid.
If you are eligible for Medicare, speak to a licensed insurance agent to find out if Dual-eligible Special Needs Plans are available in your area and what they cover.
Speak with a licensed insurance agent
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
Where you've seen coverage of Christian's research and reports: