Does Medicare Cover an Emergency Room Visit?

Understanding Medicare coverage for emergency room (ER) visits is important for beneficiaries. This article clarifies how Medicare covers ER care, outlining coverage components and potential financial responsibilities.

Medicare Part B Coverage for Emergency Services

Medicare Part B, Medical Insurance, covers emergency room services for injuries, sudden illnesses, or rapidly worsening conditions. This coverage applies whether care is received at a hospital or a freestanding emergency department. Part B covers initial services provided in an ER setting.

Part B covers doctor services, hospital facility fees, diagnostic tests like X-rays and laboratory work, and medical supplies used during the visit. This coverage applies regardless of whether the patient is admitted or treated and released.

Emergency services are covered even if the hospital does not accept Medicare assignment, though out-of-pocket costs may be higher. Medicare Part B covers emergency services at any ER or hospital throughout the United States.

Inpatient Admission and Observation Status

A distinction exists between being admitted as an inpatient and being placed under observation status, impacting Medicare coverage. If a patient is formally admitted as an inpatient, Medicare Part A, Hospital Insurance, covers the hospital stay. Part A covers services like a semi-private room, meals, nursing services, medications administered during the stay, and other hospital services and supplies.

However, if a patient is placed under observation status, even if they occupy a hospital bed overnight, these services are classified as outpatient care and are covered under Medicare Part B. Observation status means the patient is not formally admitted as an inpatient, which has financial implications. Medications received during an observation stay are covered by Part B as part of outpatient hospital services.

Observation status impacts coverage for skilled nursing facility (SNF) care. Medicare Part A requires a qualifying inpatient hospital stay of at least three consecutive days before it covers SNF services. Time spent under observation status, or in the emergency room before formal admission, does not count toward this three-day inpatient stay requirement. This distinction means that a patient under observation for several days might not meet the criteria for Medicare-covered SNF care, potentially leading to significant out-of-pocket expenses for subsequent SNF stays.

Related Services and Follow-Up Care

Beyond the immediate emergency room visit and subsequent hospital stay, Medicare also covers related services and follow-up care. Emergency ambulance transportation is covered by Medicare Part B when medically necessary, such as when other transportation methods could endanger health. This coverage applies to transport to the nearest appropriate medical facility.

Prescription drugs administered during the emergency room visit or an inpatient hospital stay are covered as part of the facility or hospital services. However, prescriptions filled at a pharmacy after leaving the emergency room or hospital are covered under Medicare Part D.

Subsequent medical appointments, diagnostic tests, or specialist consultations following discharge from the ER or hospital are covered by Medicare Part B. These services are considered outpatient care. For individuals requiring continued support at home, home health care services may be covered by Medicare Part A or Part B, depending on specific circumstances and medical necessity. This can include intermittent skilled nursing care or therapy services, provided the patient meets specific criteria such as being homebound.

Your Financial Responsibility

Understanding potential out-of-pocket costs for an emergency room visit and related care is important for Medicare beneficiaries. For services covered under Medicare Part B, beneficiaries are responsible for an annual deductible. In 2025, the Medicare Part B annual deductible is $257. After meeting this deductible, beneficiaries pay 20% of the Medicare-approved amount for most Part B-covered services, including doctor’s services and outpatient hospital services.

If an emergency room visit leads to a formal inpatient admission, Medicare Part A costs apply. In 2025, the Medicare Part A deductible for hospital admissions is $1,676 per benefit period. A benefit period begins when a patient is admitted to a hospital or skilled nursing facility and ends when they have not received inpatient hospital or SNF care for 60 consecutive days. Coinsurance payments for Part A inpatient hospital stays begin after 60 days in a benefit period, with daily amounts increasing for longer stays.

For prescription drugs covered by Medicare Part D, beneficiaries may face deductibles, copayments, or coinsurance, depending on their specific plan. For 2025, no Medicare prescription drug plan can have a deductible exceeding $590. Supplemental coverage, such as Medigap policies or Medicare Advantage plans (Part C), can help manage some or all of these out-of-pocket costs, including deductibles, copayments, and coinsurance. Total out-of-pocket expenses can vary based on the type of care received, whether it results in an inpatient admission or observation status, and any additional insurance coverage.