Are emergency room visits covered by Medicare?

Medical coverage in an emergency can be a major expense for many Americans. Medicare can protect many people from sudden costs, allowing them to get treatment as soon as they need it instead of attempting to avoid an emergency room visit.

The part of Medicare that covers emergency room visits varies based on whether or not you are admitted to the hospital. Learning about when Medicare covers ER visits can help you be prepared for an emergency.

When does Medicare Part A cover emergency room visits?

Medicare does cover emergency room visits, but the form of that coverage varies based on whether or not a doctor decides to admit you to a hospital. 

If you’re admitted, Medicare Part A can cover your ER visit and inpatient hospital stay for a maximum of 90 days, as long as the hospital accepts Medicare. If you need more time, you could qualify for up to another 60 days of coverage through lifetime reserve day use. This means that people can get a total of 60 additional days in the hospital throughout their lifetimes.

Usually, Part A only covers emergency room visits if you stay in the hospital for an entire night and a doctor signs an order formally admitting you. However, coverage only takes effect if you’re admitted to the hospital that the emergency room is attached to. If you go to another hospital, the emergency room visit will be covered by Part B instead.

Medicare ER Deductibles

A deductible is an amount you need to pay before Medicare covers emergency room visits. For example, if you have already met your Medicare Part B deductible amount by going to a doctor or getting other medical services, then you won’t have to pay for emergency visits covered by Part B.

On the other hand, there is a maximum deductible per benefit period for Medicare Part A. Benefit periods start at hospital admission and end when a patient has been out of a hospital or a skilled nursing facility for 60 days. You may have to pay a deductible for each admission under Medicare Part A. 

Medicare ER Copays

A copayment or copay is a percentage a person has to pay after paying their deductible, and insurance helps with some costs. 

The copays for Medicare Part B are usually 20%, but some services may have higher or lower rates. Copays for Medicare Part A only appear after a person’s first 60 days in the hospital.

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Does Medicare Advantage cover ER visits?

Medicare Advantage, also called Part C, is offered by a variety of private companies. It must cover everything that Original Medicare covers, including emergency room visits. These plans often include prescription drug coverage or Medicare Part D as well.

Will Medicare cover an emergency room visit outside the United States?

Medicare doesn’t normally cover care at hospitals or emergency rooms outside the country. However, people with travel plans can buy additional Medigap coverage that can help with the cost of any medical care away from the U.S. 

People also call this Medicare Supplement Insurance, which will also help cover some copays and deductibles when you’re inside the United States. However, Medigap plans for people new to Medicare no longer cover the Medicare Part B deductible.

What You Need to Know About Medicare ER Visits

Medicare Part A and Part B cover emergency room visits, but the details of your coverage can vary depending on the circumstances. You can check with your Medicare Advantage provider for details. You can also compare health insurance quotes to make sure you’re getting the best deal.

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