Does Medicare Cover Emergency Room Visits?

Yes, emergency room visits are typically covered by Medicare.

Most outpatient emergency room services are covered by Medicare Part B, and inpatient hospital stays are covered by Medicare Part A.

Doctor talking with her patient

What Medicare Part A covers

Medicare Part A hospital insurance helps cover:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Hospice care
  • Some home health care services

Medicare Part A is typically premium-free, as long as you or your spouse paid sufficient Medicare taxes while working.

If you go to the emergency room and are admitted as an inpatient, Medicare Part A helps cover some of the costs related to your hospital stay once your Part A deductible is met.

In 2019, the Medicare Part A deductible is $1,364 per benefit period.

What Medicare Part B covers

Medicare Part B is known as medical insurance and helps cover medically necessary services and preventive services, which can include:

  • Doctor’s office visits
  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health services

Medicare Part B may also cover services you receive when you visit the emergency room as an outpatient.

Medicare Part B is optional, and if you enroll in Part B you must also enroll in Part A. Unlike Medicare Part A, which is premium-free for most people, you must pay a monthly premium for Medicare Part B.

The standard Part B premium in 2019 is $135.50 per month.2

Emergency room copayments and coinsurance

Even if your emergency room visit is covered by Medicare, you are typically responsible for paying a portion of the costs, known as copayments or coinsurance.

Typically, you pay a Medicare emergency room copayment for the visit itself and a copayment for each hospital service.

How you are charged depends on several factors, including which part of Medicare covers your visit (Medicare Part A, Medicare Part B or both) and whether or not you have met your Part A and Part B deductibles.

In 2019, the Part A deductible is $1,364 per benefit period, and the Part B deductible is $185 per year.

Medicare Part A coinsurance

Generally, if you go to the emergency room and are admitted as an inpatient, Medicare Part A will cover a portion of the costs, and in 2019 you pay:

  • $0 coinsurance for each benefit period for days 1-60 spent in the hospital
  • $341 coinsurance for days 61-90 in each benefit period
  • $682 coinsurance per each “lifetime reserve day” beyond day 90 in each benefit period
  • All costs beyond lifetime reserve days

Remember, you must meet your Part A deductible before Medicare will pay its share for covered services.

Medicare Part B copayments

If you go to the emergency room and receive care from a doctor but are not admitted as an inpatient, Medicare Part B will typically cover a portion of your medical costs.

After your Part B deductible is met, you typically pay 20 percent of the Medicare-approved amount for most services, and Medicare pays the rest.

Medicare Advantage plans cover emergency room visits

Medicare Advantage (Medicare Part C) is an alternative to Original Medicare (Medicare Part A and Part B) that provides the same hospital and medical benefits as Original Medicare. This means that Medicare Advantage plans, like Original Medicare, will cover at least some of your emergency room costs.

Most Medicare Advantage plans also cover prescription drugs, and many plans may also offer additional benefits such as dental, vision and hearing coverage.

To learn more about Medicare Advantage plans that may be available in your area and to find out about the emergency room coverage they offer, speak with a licensed insurance agent today by calling TTY Users: 711, 24 hours a day, 7 days a week.

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