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For ACA Plans: Emergency Room Visits Will Cost More in 2017

By Kyle Marshall | November 10, 2016 | Healthy Lifestyle, Insurance Education

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The cost of emergency room care is becoming an emergency of its own.

Care received in the ER costs substantially more than similar treatment in an urgent care center or from a primary care physician. A typical ER visit is about $1,900, according to BCBSNC claims data. And that’s without being admitted to the hospital.

These high costs for emergency care are prompting changes in out-of-pocket costs for customers who buy their own health insurance through the federal marketplace. There are two major changes for people buying plans for 2017:

  • Higher costs for ER visits
  • Lower costs for seeing your primary care physician

emergency room visits


What’s Different for 2017

If you have an Affordable Care Act plan, and you go to the ER, you’ll need to meet your deductible before any benefits kick in. (A deductible is the amount you owe before your health insurer starts to pay.)

Then, after you’ve met your deductible for the year, you’ll have a copayment for an ER visit – anywhere from $500 to $600. (A copayment is a fixed dollar amount you pay for a covered service at the time you receive it.)

For example: If you have a $5,000 deductible, and you’ve not had any medical needs up to that point in the year, you’ll pay the full charges for a trip to the ER, up to $5,000. But after you’ve met your deductible for the year, you’d only be responsible for the copay.

Meanwhile, we’re making primary care more affordable for ACA customers in 2017. Here’s more on this change and the benefits of having a primary care physician.


The ER Is Costly

ER care can cost almost seven times more than seeing primary care or going to an urgent care center, according to a 2012 report from the National Center for Health Statistics.

What’s more, of the 128 million ER visits a year across the United States, a whopping 63 percent aren’t life-threatening emergencies – and only 11 percent of those patients end up being admitted for a hospital stay.

We have an obligation to all of our customers to work to rein in rising health care costs. In the long run, everyone benefits when patients get the right care in the right setting and when we make a dent in rising health care costs.


Know Your Options for Care

ER visits certainly have their place in health care. When you or a loved one are having a medical emergency – like chest pains, seizures or heavy bleeding – seek immediate care either at the ER or by calling 911. It’s a good idea to understand your care options before you face such an emergency.

Here are some alternatives:


  • Health Line Blue, a no-cost service offered by BCBSNC, is designed to help you make informed care decisions. Trained nurses are available 24 hours a day, seven days a week to help evaluate illness or injury so you can make treatment decisions that are best for you. Call toll-free at 1-877-477-2424.
  • Urgent care centers, which offer convenient, walk-in options for non-life-threatening illnesses and injuries, can save you both time and money. Find one near you using our provider search tool.
  • Primary care physicians, many of whom can provide services from splints to stitches in their offices, are often the lowest-cost options for customers. Check to see if your provider offers same-day appointments for illness or injury – many do. If you don’t have a primary care doctor, you can also use our provider search to find one that’s nearby and in your network.