Does Medicare Cover Emergency Room Visits?

Published by: Medicare Made Clear

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.

 

 

How Much Does an ER Visit Cost?

 

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.

 

 

Costs can change if you are admitted to the hospital

 

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.

 

 

Does Medicare Advantage Cover ER Visits?

 

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.

Learn More About Coverage for Your Prescriptions, Providers, and Other Benefits

Medicare Made Clear

Get to Know Medicare

Medicare Made Clear is brought to you by UnitedHealthcare to help make understanding Medicare easier. Click here to take advantage of more helpful tools and resources from Medicare Made Clear including downloadable worksheets and guides.

Medicare Made Clear

 

Whether you're just starting out with Medicare, need to brush up on the facts, or are helping a loved one, start your journey here.

 

Introduction to Medicare 

Get the Latest

 

Boost your Medicare know-how with reliable, up-to-date news and information delivered to your inbox every month.

Sign up now

Explore More Medicare Topics

Find a Plan

Call Us

Call UnitedHealthcare at FED TFN, TTY 711 (toll-free)

 

Hours: 8 a.m. – 8 p.m.

7 days a week

Call UnitedHealthcare at MEDSUPP TFN, TTY 711 (toll-free)

 

Hours:

7 a.m. to 11 p.m. ET,

Monday – Friday

9 a.m. to 5 p.m. ET, Saturday

Meet with Us

Make an appointment with a licensed insurance agent/producer in your area