Are emergency room visits covered by Medicare?
Medicare covers emergency room visits. If you are not admitted to the hospital, Medicare Part B pays for your ER visit, and you will be responsible for your deductible and coinsurance. If you are admitted, Medicare Part A covers the emergency room costs as part of an inpatient stay. Medigap insurance covers some or all of the out-of-pocket costs of an ER visit.
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UPDATED: Jan 21, 2022
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- Medicare covers emergency room visits, but there is a copay and your deductible applies
- Part B will cover emergency room charges, but Part A will apply if you are admitted
- Medicare covers ER visits in foreign countries in very specific situations
When you’re injured or suddenly become ill and need to go to the emergency room, the last thing you want to think about is the cost. Knowing your insurance coverage will give you peace of mind. Does Medicare cover emergency room visits? What will the out-of-pocket costs be? Does Medicare cover emergency room visits in another country?
Emergency room Medicare coverage can be confusing, but we’ve got all the answers you need. Read on to find out how Medicare covers the ER, what your Medicare emergency room copayment will be, and more.
Before you learn all about Medicare coverage for the ER, take a minute to compare your Medicare coverage options. Enter your ZIP code for free Medicare quotes today.
Does Medicare pay for emergency room visits?
Medicare will cover your visit to the emergency room, but which coverage applies depends on whether or not you are admitted.
If you are not admitted to the hospital after your ER visit, Medicare Part B will pay for the ER service. In this case, you will have to meet your Part B deductible and pay 20% coinsurance.
If you are admitted to the hospital during the ER visit or within three days of that visit for the same condition, Medicare Part A will apply. In this case, the ER visit will be considered a part of your hospital stay, and Part A will cover all of the costs.
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What is the cost of an emergency room visit with Medicare?
As noted above, which part of Medicare covers your ER visit will depend on whether or not you are admitted to the hospital. This will also impact how much you pay out-of-pocket for coverage.
If you are not admitted, you can expect to pay your Part B deductible if you haven’t already met it for the year, which is $233. After that, you will pay 20% of the bill as your Part B coinsurance. How much that is exactly will depend on what services you receive in the ER.
If you are admitted, costs will be different. Part A will cover the emergency room, and there will be no deductible or copay. In order for this to apply, you must:
- Be admitted during the emergency room visit or within three days of that visit
- Be admitted for the same or a related condition that was the reason for the ER visit
- Be admitted to the same hospital
If you have Medicare Supplement (Medigap) insurance, some or all of the out-of-pocket costs will be covered.
If you are on a Medicare Advantage plan, your deductibles, coinsurance, and coverage will vary. Check with your specific plan to find out what you will pay for an emergency room visit. You also need to make sure you are one of the hospitals that accept Medicare. This could be different depending on what Advantage plan you have.
Does Medicare cover ER visits out of the country?
As a general rule, Medicare doesn’t cover emergency room visits if you are outside the U.S. There are, however, some exceptions. These are the situations in which Medicare will pay for ER services in a foreign country:
- You have a medical emergency in the U.S., but a foreign hospital is closer than any of the U.S. hospitals
- A medical emergency occurs in Canada while you are driving through on a direct route to Alaska without reasonable delay
- You visit an emergency room for a non-emergency reason when a foreign hospital is the closest place that can treat that particular condition
Medicare Advantage plans will have their own rules for coverage outside the U.S., so make sure you know before you go.
Medicare Supplement coverage does provide coverage for emergency room visits in foreign countries if you have the right plan. Again, check your plan before you leave. There will be a deductible and coinsurance, and coverage only applies within 60 days of leaving the U.S.
Does Medicare cover emergency room visits? The Bottom Line
Does insurance cover emergency room visits if you are on Medicare? Yes, you’re covered.
Medicare will cover your emergency room visit under either Part A or Part B, depending on whether or not you are admitted. Coverage in foreign countries is very limited, but a Medicare Supplement plan can provide additional protection.
To make an ER visit with Medicare affordable, you may want to consider either a Medicare Advantage or Medigap plan. Enter your ZIP code now to compare rates for Medicare coverage today.