“What Are Emergency and Urgently Needed Services?” is locked What Are Emergency and Urgently Needed Services?Emergency services these are covered inpatient and outpatient services you receive from a qualified provider. An emergency medical condition has symptoms that are severe enough that someone with an average knowledge of health and medicine could reasonably expect your health to be in serious danger if you do not get medical attention right away.

An emergency medical condition can result in:

  • Serious danger to your health, or if you are pregnant, the health of your unborn child
  • Serious damage to bodily functions, parts, or organs

Urgently needed services are covered services that:

  • Are not emergency services as defined above, but are medically necessary and immediately required as a result of an unforeseen illness, injury, or condition
  • You receive when you are temporarily outside of your Medicare Advantage Plan’s service area or when you are in the service area but the network is temporarily unavailable or inaccessible, and
  • Given the situation, it is not reasonable for you to wait to get the needed services from your regular plan provider after you return to the service area, or when the network becomes available

These definitions are important if you have a Medicare Advantage Plan, because there are certain protections you have if you need emergency or urgent care outside of your plan’s network (read: What if I receive emergency or urgently needed services from an out-of-network provider?).

If you have Original Medicare, you can receive emergency or urgently needed services from any provider who accepts Medicare throughout the U.S., and there are some protections that exist if you see an opt-out provider (read: What if I receive emergency or urgently needed services from an opt-out provider?).

Read More: How Does Medicare Cover Emergency Room Services?
Learn About:  How Does Medicare Cover Ambulance Transportation?
Return to: Medicare In-Depth

