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Mercado Oficial de Seguros de Salud

El mercado de seguros de salud del estado de California desde 2013

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Emergency Room Coverage in California

All Covered California plans cover emergency room visits, even at out-of-network hospitals. Learn about ER costs, when to use urgent care instead, and how to avoid surprise bills.

Emergency Room Coverage Basics

Emergency care is an Essential Health Benefit. All plans must:

  • Cover ER visits: At any hospital, in-network or out-of-network
  • Apply in-network rates: Even at out-of-network ERs
  • No prior authorization: Coverage doesn't require pre-approval
  • Cover stabilization: Until you can be safely transferred or discharged
What's an Emergency? A medical condition with severe symptoms (including severe pain) where a reasonable person would believe that without immediate care, their health would be seriously jeopardized.

Emergency Room Costs by Plan

ER costs vary significantly between plan tiers. These are Covered California's standard 2027 plans:

Plan (2027) Emergency Room Urgent Care Deductible
Bronze 60 40% $60 $5,800
Silver 70 $400 $50 $4,700
Silver 73 $400 $50 $4,700
Silver 87 $200 $15 $1,100
Silver 94 $50 $5 $200
Gold 80 $350 $40 $0
Platinum 90 $225 $20 $0

A percentage is your share of the plan's allowed amount. Your plan's summary says what the deductible applies to, and the quote form shows each plan's costs for you.

Fee Waived: On Covered California's standard plans, the emergency room fee is waived if you're admitted to the hospital. The plan's hospital stay costs apply instead.

ER vs Urgent Care

Choosing the right care setting can lower what you pay:

Go to the ER For:
  • Chest pain or heart attack symptoms
  • Stroke symptoms
  • Severe difficulty breathing
  • Heavy bleeding
  • Severe head injury
  • Broken bones with skin puncture
  • Poisoning or overdose
  • Severe burns
  • Loss of consciousness
Urgent Care For:
  • Minor cuts needing stitches
  • Sprains and minor fractures
  • Ear infections
  • Flu symptoms
  • UTIs
  • Minor allergic reactions
  • Fever without rash
  • Back pain
  • Pink eye
Cost Comparison
  • ER Visit: $400 on the standard Silver 70 plan in 2027
  • Urgent Care: $50 on the standard Silver 70 plan in 2027
  • Telemedicine: Often the lowest cost; your plan says what it charges

Out-of-Network Emergency Care

The federal No Surprises Act protects you from surprise ER bills:

  • Same cost-sharing: You pay in-network rates at any ER
  • No balance billing: Providers cannot bill you beyond your cost-sharing
  • Counts toward maximum: Out-of-network ER costs apply to your out-of-pocket max

California's own law, AB 72, gives similar protection for non-emergency care from out-of-network providers at in-network facilities.

After Stabilization: If you're stable and choose to stay at an out-of-network hospital for ongoing care, normal out-of-network rates may apply.

Tips to Save on Emergency Care

  1. Use telemedicine first: For non-emergencies, start with a virtual visit
  2. Know your urgent care options: Find in-network urgent care centers near you
  3. Call the nurse line: Most plans have 24/7 nurse lines for guidance
  4. Review your bill: Check for errors and ask for itemization
  5. Request a payment plan: Hospitals typically offer interest-free options

Questions About ER Coverage?

Our agents can help you understand your plan's emergency benefits and find alternatives for non-emergencies.

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