Does Medicare Cover Visits to the ER? 

A medical emergency can occur to anyone at any time, but studies show that trips to the emergency room become more common as people get older. In fact, these numbers reveal that over 16 percent of adults in the United States who are 65 and older are treated in hospital emergency rooms annually. 

Most people who are older than 65 visit hospital emergency rooms across the country for the following reasons: 

1. Injuries due to falls which are the leading cause of injury (fatal and non-fatal) for seniors. 
2. Injuries due to car accidents 
3. Problems with medications due to dosage mistakes or serious side effects.  
4. Heart problems such as chest pain, shortness of breath, heart attack, etc. 
5. Complications of diabetessuch as dehydration, hypoglycemia, heart attack, stroke, wounds, ulcers, etc. 

While it’s comforting to know that emergency care is available if you need it, visits to a hospital emergency room can be expensive if you don’t have insurance coverage. How much you pay depends on where you live, what your condition is, and what tests and treatment you get there. On average in the United States, emergency room visits cost $2,200. If you have Medicare coverage, your insurance may cover a portion of the cost of emergency room visits, here’s a look at how Medicare helps with these expenses.

How does Medicare cover emergency room visits? 

Original Medicare Part B, which is outpatient medical insurance, typically covers visits to a hospital emergency room if you have an injury, sudden illness, or an illness that suddenly gets much worse. Medicare Part B provides this coverage for visits to any hospital emergency room at any hospital in the country. 

Original Medicare Part B pays for 80 percent of the final approved cost for doctor’s services you get during the visit to the emergency department if you aren’t admitted to the hospital for care. You are considered an outpatient even if you stay overnight in the emergency room. As an outpatient, you are responsible for the remaining 20 percent of the cost for your care (after meeting your annual Part B deductible) as well as a copayment for each visit to the emergency room and a copayment for each medical service you get in the hospital emergency room. 

If your health care provider formally admits you into the same hospital for a condition related to your emergency room visit within three days of that visit, you become a hospital inpatient. This means that Original Medicare Part A, which is inpatient hospital insurance, begins covering your care. In this instance, you don’t have to pay the emergency room copayment for the related visit. If you are admitted as an inpatient in a hospital that accepts Medicare assignment, you must pay the Medicare Part A deductible for the current benefit period. As of 2022, the Part A deductible is $1,556.00. 

Medicare beneficiaries who have insurance through a Medicare Advantage (Part C) plan also have coverage for visits to hospital emergency rooms anywhere in the United States. In cases of emergencies, you don’t need to use hospitals that are within your plan’s network. 

However, your out-of-pocket costs may vary depending on the Part C Medicare Advantage plan you have. Some plans might require that you pay a copayment for the emergency room and physician. And other plans may charge a specific fee for every emergency room visit plus a coinsurance charge for each service you get while you are there. 

To find out more about how your provider charges for emergency room visits, read your plan policy or call your provider for more detailed information.