Does Medicare cover emergency room visits?

Yes, Medicare covers emergency room visits for injuries, sudden illnesses or an illness that gets worse quickly. Specifically, Medicare Part B will cover ER visits. And, since emergencies may occur anytime and anywhere, Medicare coverage for ER visits applies to any ER or hospital in the country. Note though, Medicare only covers emergency services in foreign countries in select situations.

Medicare typically charges a copay for each emergency room visit and copays for hospital services you receive during the visit. In addition to these copays, you will pay a coinsurance for doctor services you receive in the ER. Medicare Part B typically pays 80 percent of the Medicare-approved amount for doctor services, and you are responsible for the remaining 20 percent of the cost. The Part B deductible also applies.

The total amount you actually pay for an ER visit will depend on the type of facility you go to, whether you have other insurance, such as a Medicare supplement plan (Medigap) or a Medicare Advantage plan (Part C), and other factors.

If an ER visit results in being you admitted to the hospital, then the visit is considered part of an inpatient stay and ER-related copays would not apply. To qualify as such, a hospital admission must happen within three days of the ER visit for the same or a related condition, and it must be at the hospital where ER services were provided. Admission to a different hospital within three days, even for the same condition, would be considered a separate event.

Medicare Advantage plans cover ER visits – and everything else that Original Medicare (Parts A & B) covers. By law, these plans must offer coverage equal to or better than what Original Medicare provides. So, though Medicare Advantage plans typically have provider networks, they must cover emergency care from both network and out-of-network providers. In other words, Medicare Advantage plans cover ER visits anywhere in the U.S.

Each Medicare Advantage plan sets its own cost terms for ER visits and other covered services. For example, you may pay copays or coinsurance for an ER visit and for services you receive while in the ER. Some plans also have deductibles. It’s important to check each plan’s details for information about coverage for ER visits.