Emergencies happen. Knowing who to call and where to go can help keep costs low, while helping ensure that you get the right care at the right time.
If the words “unexpected medical costs” make you shudder, you’re not alone. More than half of Americans ages 65 and over with insurance are at least somewhat worried about these, a 2020 Kaiser Family Foundation survey found.
A big concern is what happens when your health suddenly goes awry — and how you’ll pay for it. First, some reassurance: According to the National 911 Program (the federal home for 911 services), most people rarely face emergencies. But when and if an incident occurs, you want to feel you have some control over the costs. And that begins by planning ahead.
“The best way to avoid surprise costs with unplanned emergency care is to do some homework in advance, just as you would when you’re trying to save on the costs of your routine care,” says Katy Votava, Ph.D., R.N., a consultant and author based in Rochester, New York, who specializes in health economics and helps older Americans plan for their health care needs in retirement.
Ready for Paying for Emergencies 101? Class begins right now. Follow the lessons Votava says every older adult should learn.
Lesson #1: Learn When to Go to the ER — and When Not To
Emergency departments are able to treat just about anything, but that doesn’t mean going to the emergency room (ER) is always your best move. When a 2019 UnitedHealth Group study compared treatment costs for a non-emergency condition at three places — ER, urgent care clinic and doctor’s office — the disparities were extreme. The ER cost was 12 times higher than visiting a primary care provider and 10 times higher than going to an urgent care clinic.
At your Annual Physical and Wellness Visit, ask your health care provider for a list of symptoms that warrant a trip to the ER, based on your current health and the medications you’re taking. In fact, you should get this info whenever you get a new diagnosis or drug.
Difficulty breathing, heavy bleeding, a major bone break — these are all situations that require immediate care. A broken finger or sprain, on the other hand, is less dire and could be treated at an urgent care clinic. For help knowing where to go for care when something unexpected happens, read Provider’s Office, Telemedicine or Urgent Care? Where to Turn for Help here.
“If your illness or injury is a matter of life and death, don’t let anything stop you from making that call to 911,” says Votava. Minutes or even seconds can make a difference in the outcome — and the better the outcome, she adds, the less you may have to spend on future health care.
Lesson #2: Know Your Network Providers
Most Medicare Advantage plans have a broad network of hospitals and facilities, including urgent care centers. Your costs and copays will usually be lower when you stay within your network. Emergency care, urgent care and out-of-area dialysis services are covered when you need them.
It’s a good idea to take a moment now, when you have no immediate needs, to look up the facilities near you that are part of your plan’s network. Then, if you do happen to break a finger or sprain your wrist, you’ll know which urgent care clinic to call. Finding provider locations is easy: Sign in or register on your plan website. Then click on Find Care.
If you receive emergency care at an out-of-network hospital and need inpatient care after your emergency condition is stabilized, you must return to a network hospital in order for your care to continue to be covered. Or, you must have your inpatient care at the out-of-network hospital authorized by the plan and your cost is the cost-sharing you would pay at a network hospital.
The best way to know your plan’s specifics is to read through your Evidence of Coverage, located in the Coverage & Benefits page of your plan website. Or call the Customer Service number listed on the back of your member ID card.
Lesson #3: Take Advantage of Your Plan’s 24/7 Services
Your plan also offers different ways to get care without leaving home, and they’re available any time of day, every day of the week1.
If you just need advice on what to do next, call the 24/7 nurse hotline to talk to a registered nurse. The nurse can advise you on steps to take that can help you feel better without leaving home, and may even have a prescription called into your pharmacy. Look for the number on your member ID card2.
Telemedicine is another way to get care for certain unexpected health issues. A virtual visit allows you to meet one-on-one with a network health care provider regarding urgent care needs like flu, allergies, pink eye and more. Most UnitedHealthcare Medicare Advantage plans have $0 copays for covered telehealth services3.
Lesson #4: Make an Emergency Plan for Your Travels
Planning a trip? Before you go, double-check your UnitedHealthcare Medicare Advantage plan’s coverage details for travel. Or give your Customer Service team a call. Many plans provide out-of-network coverage usually for a higher cost.
If you travel often or move homes with the seasons, we’ve got you covered. Your plan may have nationwide coverage through our National Network or UnitedHealth Passport®. These features allow you to get care from contracted providers while you’re away from home at the same in-network costs you’re used to. (Note: National Network size varies by market and exclusions may apply.)
Finding Your Plan Extras is as Easy as 1, 2, 3
Think of your plan website as Grand Central Station for everything related to your plan coverage. To check benefits:
- Go to MyUHCMedicare.com.
- Sign in or click Register Now to create an online account.
- Click Coverage & Benefits to see a recap of your plan’s benefits.
Lesson #5: After the Fact, Review Any Bills Carefully
If you receive a bill after a trip to the emergency room, review it carefully, says Votava. The only amount you should owe is your cost share, if any. If you have any questions, or if the provider is saying something different, call the Customer Service number on the back of your member ID card.
“Mistakes happen,” she says. “So, don’t just pay a bill. Make sure you understand it and ask questions if you don’t, so you’re only paying the portion you need to pay.”
And if you need help paying, there are a few places to turn. Many hospitals offer payment assistance to low-income patients. Eldercare Locator, a service from the U.S. Administration on Aging, can help you find out if you are eligible for Medicaid or the Medicare Savings Program, but the best time to look into this option is when you’re well. (800-677-1116; Eldercare.acl.gov)
1. Benefits and availability may vary. 2. Nursing hotline not for use in emergencies, for informational purposes only. 3. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.