Will My Medicare Policy Cover a Visit to the ER?

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Part B of Original Medicare covers emergency visits since emergency room (ER) visits are considered outpatient care. Should your visit turn into a hospital admittance, Part A of your plan would cover your costs. Keep in mind you will still need to pay copays, coinsurance and deductibles.

Keep reading to see how the different parts of Medicare work together to cover your healthcare costs.

Key Takeaways

  • You will need to meet your Medicare deductibles before Medicare Part B will cover your ER services.
  • If you’re hospitalized within three days of your ER visit, it will be considered part of your inpatient care, which is covered by Medicare Part A.
  • An emergency room visit can cost $2,600 out-of-pocket.
  • Part D can help with medication issued to you after you’ve been released from the emergency room.
  • Medigap can help cover your deductibles as well as your ER copays and coinsurance.

How Much Does Medicare Cover for Emergency Room Visits?

Medicare covers ER visits after you've met your deductible, minus any copays or coinsurance costs. If you are admitted to the hospital for an inpatient stay following an ER visit, additional costs might apply.

What Parts of Medicare Cover Emergency Room Visits?

Several parts of Medicare can play some role in covering your emergency room visit.

Plan Type

Coverage Breakdown

Medicare Part A

Covers your full hospital stay if admitted

Medicare Part B

Covers 80% of ER outpatient costs after meeting Part B deductible, with additional copays per service

Medicare Part C

Required to provide the same coverage as Part A and B

Medicare Part D

Not applicable as Part A and B typically provide coverage for medication


Can help cover deductibles, copays and coinsurance

Medicare Part A

Part A (hospital insurance) of Original Medicare doesn't cover emergency room visits because the ER is considered outpatient care, not inpatient. However, should an ER visit lead to a hospital admission within three days of your initial visit, Part A will cover your treatment as the emergency room visit will be considered a part of your inpatient stay but only after you've met your $1,600 deductible.[1] Remember that between 2014 and 2017, 23% of ER visits led to hospitalizations for those 60 and up.[2]

Keep in mind, however, that you will have to pay your deductible over again for every pay period (60 days between receiving inpatient services).[1] This means you could pay multiple deductibles several times a year depending on how often you get inpatient care. Copays will also apply and can be as high as $800 depending on how long your stay is.[1]

Medicare Part B

Part B (medical insurance) is specifically designed to cover outpatient medical services, including emergency room visits. You will have to meet your yearly deductible of $226 as well as a 20% coinsurance.[1]

Additionally, you will pay a separate copay (typically 20% of covered services) for each Medicare-approved service you receive during your outpatient care.[1] If you are admitted to the same hospital for a related condition within three days of visiting the ER, you won't need to pay your copays as your visit will fall under inpatient care.[3]

Medicare Advantage

Also called Medicare Part C, Medicare Advantage plans provide Medicare coverage but the plans are issued by private insurance companies.

Similar to Original Medicare, Medicare Advantage plans must also cover emergency room visits. However, the copayments and other costs can differ, so it’s essential to consult your plan for details.

For instance, a Blue Cross Medicare Advantage Classic (PPO) plan can have a $90 copay for an ER visit while a CareFirst BlueCross BlueShield Advantage Core (HMO) plan can have a $95 copay.[4][5]


Medigap, or Medicare supplement insurance, can aid in covering the “gaps” in Original Medicare, such as copayments, deductibles and coinsurance. If you have a Medigap policy, it might cover some of the costs that Medicare Part B does not cover during an ER visit. You can enroll in Medigap once you have Original Medicare.

Does Medicare Have Copays for Hospital Visits?

Original Medicare will typically require you to pay a copayment when visiting the emergency room. The copay amount can vary widely based on your coverage and the nature of the medical services received. For instance, Part A breaks down hospital copays as follows:[1]

  • Days 1-60: $0 after your deductible is met
  • Days 61-90: $400 every day
  • Days 91-150: $800 every day while using your 60 lifetime reserve days
  • After day 150: You pay all costs

How Much Is an Emergency Room Visit Without Medicare?

Without Medicare coverage, the cost of an emergency room visit can be exorbitant with prices being $2,600 or higher depending on the provider.[6] Additional costs can be incurred for tests, treatments and if hospital admission is necessary.

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How long can you stay at the hospital with Medicare?

Medicare Part A covers up to 60 days of inpatient hospital care for each benefit period after the beneficiary has met the Part A deductible.[7] Beyond 60 days, additional costs apply.

What is the Medicare deductible for an emergency room visit?

For emergency room visits under Medicare Part B, you'll generally need to meet the annual Part B deductible of $226 for this year.[1] Amounts can change yearly.

Does Medicare pay for emergencies?

Medicare does provide coverage for emergency situations, including emergency room visits, under Part B as well as if you have a Medicare Advantage plan.

Does Medicare cover ambulance rides?

Medicare Part B may cover ambulance services to or from a hospital or a skilled nursing facility when other transportation could endanger your health. However, you are typically responsible for 20% of the Medicare-approved amount.[8]

Will Medicare pay if I visit the ER twice on the same day?

Medicare Part B has a limitation on covering multiple visits in a single day; it will only cover two visits if they are for distinct, unrelated reasons. If a return visit occurs on the same day for an identical condition, the subsequent visit will not be eligible for coverage.


  1. Medicare.gov. “Costs.” Accessed September 1, 2023.
  2. National Institutes of Health. “Emergency Department Increased Use of Observation Care for Elderly Medicare Patients.” Accessed September 1, 2023.
  3. Medicare.gov. “Emergency Department Services.” Accessed September 1, 2023.
  4. BlueCross BlueShield of New Mexico. “Summary of Benefits,” Page 6. Accessed September 1, 2023.
  5. UnitedHealthcare. “What Are My Care Options and Their Costs?” Accessed September 1, 2023.
  6. CareFirst “Summary of Benefits,” Page 4. Accessed September 1, 2023.
  7. Medicare.gov. “Inpatient Hospital Care.” Accessed September 1, 2023.
  8. Medicare.gov. “Ambulance Services.” Accessed September 1, 2023.

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