Emergency Room Care

Emergency room care refers to medical services provided in a hospital emergency department for conditions that require immediate attention. Under the ACA, all health insurance plans are required to cover emergency services — including at out-of-network hospitals — without requiring prior authorization and without charging you more than in-network cost-sharing rates.

What this means in practice:

• You cannot be turned away from an ER and later denied coverage because the hospital was out-of-network
• Your insurer must apply your in-network deductible, copay, and coinsurance to ER visits, even at out-of-network facilities
• You do not need to call your insurer before going to the ER in a true emergency

One important caveat: the No Surprises Act limits balance billing in ER situations, but does not eliminate all cost-sharing. You’ll still owe your regular in-network cost-sharing amounts. ER visits are often expensive even with insurance — a typical ER copay ranges from $100 to $350, and you may owe coinsurance on top of that once your deductible is met.

If your situation is urgent but not life-threatening, an urgent care center is almost always significantly cheaper than the ER and is covered at a lower cost-sharing rate on most plans.