Will My Medicare Policy Cover a Visit to the ER?

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.

On This Page

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  How Much Does Medicare Cover for Emergency Room Visits?

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  What Parts of Medicare Cover Emergency Room Visits?

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  Does Medicare Have Copays for Hospital Visits?

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  How Much Is an Emergency Room Visit Without Medicare?

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  FAQs

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.

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

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.