Does Medicare Cover ER Visits?

Medicare covers emergency room visits, but how much you pay depends on your patient hospital status. If you visit the ER but aren’t formally admitted to the hospital, you are considered an outpatient under Medicare Part B. If you are admitted, you are considered an inpatient under Medicare Part A.

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Written by
Rachel Christian
Rachel Christian
Financial Writer and Certified Educator in Personal Finance
Rachel Christian is a writer and researcher for RetireGuide. She covers annuities, Medicare, life insurance and other important retirement topics. Rachel is a member of the Association for Financial Counseling & Planning Education.
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Edited By
Matt Mauney
Matt Mauney
Financial Editor
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.
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Published: February 22, 2021
Updated: January 17, 2023
11 min read time
This page features 5 Cited Research Articles

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Emergency Room Coverage at a Glance

Medicare Plan	Emergency Room Coverage
Part A (Inpatient)	If you are admitted to the hospital, Medicare Part A covers your entire stay. Your trip will be considered an inpatient stay and ER-related copays won’t apply.
Part B (Outpatient)	Covers 80% of outpatient ER visit costs after you have reached your Part B deductible. You will also owe copayments for each service received.
Part C (Medicare Advantage)	Covers ER visits anywhere in the U.S. Costs for ER visits vary by plan.
Part D (Prescription Drugs)	N/A
Supplemental Insurance	Can help cover out-of-pocket costs related to ER visits. Coverage varies by plan.

Emergency Room Visits and Original Medicare Costs

There are two parts to Original Medicare. Medicare Part A covers inpatient hospital stays and Medicare Part B covers outpatient services.

Your hospital status — whether you’ve been formally admitted to a hospital — affects how much you pay for emergency care and what part of Medicare applies.

When you visit a hospital’s emergency department, via either an ambulance or the waiting room, you’re initially considered an outpatient. You may be considered an outpatient even if you stay overnight in the hospital.

Outpatient emergency room visits are covered by Medicare Part B.

Outpatient Emergency Department Costs Under Medicare Part B

You usually pay 20% of the Medicare-approved cost for doctor and other health care provider's services.
You’ll also usually face a copayment from the hospital for each Medicare-covered service you receive, such as X-rays or lab tests. Copays typically can’t exceed the $1,600 Part A deductible for each service.
The Part B deductible — $226 in 2023 — also applies. You may not owe this if you’ve already met your yearly deductible before arriving at the hospital.

This can be confusing. If you’re in the emergency room, how can you be an outpatient?

Medicare only provides hospital inpatient coverage after a doctor writes an order and formally admits you to the hospital.

Typically, inpatient admission takes place when you’re expected to need at least two nights of medically necessary hospital care.

If you are admitted to the hospital, Medicare Part A covers your entire stay. Your trip will be considered an inpatient stay and ER-related copays won’t apply.

Inpatient Hospital Costs Under Medicare Part A

Your $1,600 Part A deductible applies for each benefit period.
You will owe a $0 coinsurance payment for your first 60 days in the hospital.

Admission must take place at the hospital where ER services were provided. Getting admitted to a different hospital within three days, even for the same condition, is considered a separate event.

Examples of How Original Medicare Covers ER Visits

Let’s say you arrive at the ER with severe ear pain. You wait in the lobby and after you are called back, hospital staff run tests, write you a prescription for antibiotics, write you a referral for follow-up care outside the hospital and send you on your way.

This would be considered an outpatient visit because you never left the emergency department and a doctor never formally admitted you to the hospital. Your visit would be covered under Medicare Part B.

Did You Know?

A study published in 2018 found that 48 percent of Medicare beneficiaries age 65 and older who sought treatment at an ER were discharged, 10.5 percent were kept in observation and 41.5 percent were admitted to the hospital as an inpatient.

Source: U.S. National Library of Medicine

Now, let’s imagine you arrive at the ER because you are experiencing chest pain. After running tests, hospital staff learn that you suffered a heart attack. They hold you for observation before determining that you need more extensive care.

A doctor then writes an order to formally admit you to the hospital about 24 hours after you arrived at the ER.

Your entire visit, even the 24 hours you technically spent as an outpatient under observation in the ER, is now covered under Medicare Part A.

The way Medicare classifies your stay — either as an inpatient or outpatient — directly impacts your bill.

Make sure to ask the doctor or a hospital social worker if you’re an inpatient or outpatient to avoid surprises.

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Coverage and Costs of ER Visits with Medicare Advantage

Medicare Advantage plans serve as an alternative to Original Medicare.

These plans are administered by private insurance companies and often bundle benefits from Medicare Part A and Part B with Part D prescription drug coverage.

Medicare Advantage plans cover ER visits — along with everything else covered by Original Medicare.

Medicare Advantage covers ER visits anywhere in the U.S., and you aren’t required to use in-network hospitals for emergency care.

However, each Medicare Advantage plan sets its own cost terms for ER visits. These costs can differ from Original Medicare.

For example, a Medicare Advantage plan may require you to pay a copayment per visit that accounts for both the emergency room and the doctor. Or it may charge a flat fee per visit plus coinsurance for each service you receive in the ER.

Examples of How ER Costs Vary Among Medicare Advantage Plans

The way a Medicare Advantage plan bills you for a trip to the ER — and how much you owe — can vary from plan to plan.

For example, the Medicare Advantage PPO Plus Plan by Anthem Blue Cross charges beneficiaries $250 for admission to emergency room facilities plus a 20 percent coinsurance payment for services. It also charges a flat $100 rate for doctor services in the ER plus a 20 percent coinsurance payment.

Meanwhile, the Cigna‑HealthSpring Advantage HMO plan offers beneficiaries a flat $90 copayment for Medicare‑covered emergency room visits. If you’re admitted to the hospital within 24 hours for the same condition, you pay $0 for the emergency room visit with this plan. A deductible may or may not apply.

These are just two examples of how emergency room costs can differ among Medicare Advantage plans.

There are thousands of different Medicare Advantage plans across the country, so it’s important to check with your specific provider to learn how much a trip to the ER may cost you.

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