Does Medicare Cover Emergency Room Visit Costs?

Victoria Burke by Victoria Burke | Licensed since 2011

This article was updated on: 09/20/2018

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Anyone might need to go to the emergency room someday. If you have Medicare Part A and Part B, do you know what share of emergency room costs Medicare may cover?

As you may know, emergency room (ER) visits can be expensive. Almost 22% of Americans aged 65 and over had at least one ER visit in 2015, reported the Centers for Disease Control and Prevention (CDC), while one in 10 Americans aged 75 and over had at least two ER visits.

That means that if you’re in the 65-and-over age group, your chances of an emergency room visit are something to consider. And emergency room visit costs are generally higher than a visit to your doctor, reported the U.S. Agency for Healthcare Research and Quality (AHRQ).

Medicare coverage of emergency room costs

If you have a situation such as a heart attack, stroke, or sudden illness, Medicare Part B might cover some of your emergency room costs.

When Medicare covers emergency room (ER) visit costs, you typically pay:

  • A copayment for the visit itself
  • A copayment for each hospital service you receive there
  • A coinsurance amount of 20% for the Medicare-approved cost for doctor services. The Part B deductible applies.

Please note that if you’re admitted to the same hospital as an inpatient for a related condition within three days of your ER visit, you generally don’t pay the ER copayment, because Medicare Part A may cover the ER visit as part of your inpatient care.

Medicare Supplement plans and emergency room costs

You might be able to buy a Medicare Supplement (Medigap) plan from a private insurance company to help pay for some of the Original Medicare out-of-pocket costs mentioned above. Original Medicare refers to Medicare Part A and Part B, and Medicare Supplement plans can work alongside this federal program.

In fact, some Medicare Supplement plans may help cover emergency medical care when you’re out of the country (80% of covered services up to plan limits).

If you like your Original Medicare coverage but want to see if you can cover some of the out-of-pocket costs you’re responsible for, you may want to check out which Medicare Supplement (Medigap) plans might be available to you. I can help you with that.

  • Schedule a phone appointment or have me email you Medigap information tailored to your needs; use the links below to set this up.
  • Click the Compare Plans or Find Plans buttons on this page to browse Medicare Supplement plans for yourself.

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