Coverage
Does Medicare Cover Emergency Room Visits?
- January 12, 2024
- Reviewed by John Krahnert
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.
Medicare Advantage plans (Part C) also cover ER visits. Many Medicare Advantage plans also offer benefits not found in Original Medicare.
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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 2024, the Medicare Part A deductible is $1,632 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 2024 is $174.70 per month.
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 2024, the Part A deductible is $1,632 per benefit period, and the Part B deductible is $240 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 2024 you pay:
- $0 coinsurance for each benefit period for days 1-60 spent in the hospital
- $408 coinsurance for days 61-90 in each benefit period
- $816 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 may also cover benefits not included in Medicare Part A or Part B.
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.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
