Does Medicare Part A Cover Emergency Room Visits?

Medicare Part A covers inpatient hospital care, including services received after formal admission by a physician. It also extends to skilled nursing facilities, hospice care, and some home health services. Understanding the specifics of Medicare Part A helps clarify how emergency room visits are covered.

Medicare Part A Coverage for Emergency Room Visits

Medicare Part A covers emergency room (ER) visits primarily when the visit leads to a formal inpatient admission. If a doctor orders inpatient admission, Part A covers the hospital facility costs, including the ER visit itself.

However, if an ER visit does not result in inpatient admission, Medicare Part A typically does not cover the services. These services are generally considered outpatient care. Facility fees, diagnostic tests, and other services provided during an ER visit without inpatient admission usually fall under Medicare Part B coverage.

Part A’s coverage for an ER visit leading to an inpatient stay also includes related outpatient services provided up to three days before the admission date. This helps cover costs incurred in the ER that are directly tied to the subsequent inpatient care.

Understanding Inpatient vs. Observation Status

The distinction between inpatient admission and observation status is significant for Medicare Part A coverage. Inpatient status means a doctor has formally admitted an individual to the hospital, anticipating a stay of at least two midnights. This classification directly impacts whether Medicare Part A covers hospital facility costs.

Observation status, conversely, means an individual is receiving hospital services but is considered an outpatient. This can occur even if a person stays in a hospital bed for an extended period, sometimes overnight or for several days. A person under observation is not formally admitted as an inpatient, which changes how Medicare covers their care.

The determination of inpatient or observation status is made by the hospital and doctors, based on medical necessity and the anticipated length of stay. Hospitals are required to provide a Medicare Outpatient Observation Notice (MOON) if a patient is under observation for more than 24 hours. This notice explains the patient’s outpatient status and its financial implications.

This classification has important financial consequences for patients, particularly regarding subsequent care in a skilled nursing facility (SNF). For Medicare Part A to cover SNF care, a patient must generally have had a qualifying inpatient hospital stay of at least three consecutive days. Time spent under observation or in the emergency room before inpatient admission does not count toward this three-day requirement.

Consequently, individuals discharged from a hospital after an observation stay, even if lengthy, may not qualify for Medicare Part A coverage for SNF services. This can result in out-of-pocket expenses for necessary post-hospital rehabilitation or care. Medicare Advantage plans or certain Medicare initiatives may, in some instances, waive this three-day inpatient stay rule for SNF coverage.

Out-of-Pocket Costs and Other Medicare Parts

Emergency room visits under Medicare involve various out-of-pocket costs, depending on the services received and whether an inpatient admission occurs. For inpatient stays originating from an ER visit, Medicare Part A applies a deductible. In 2025, the Part A inpatient hospital deductible is $1,676 per benefit period, covering the first 60 days of a hospital stay.

If the inpatient stay extends beyond 60 days, daily coinsurance amounts apply. For 2025, the coinsurance is $419 per day for days 61 through 90, and $838 per day for lifetime reserve days from day 91 onward.

For ER visits that do not lead to inpatient admission, Medicare Part B covers the services. This includes physician services, laboratory tests, X-rays, and facility fees for outpatient ER care or observation status. Medicare Part B has an annual deductible, which is $257 in 2025.

After meeting the Part B deductible, individuals typically pay 20% of the Medicare-approved amount for most covered outpatient services. A copayment may also apply for the ER visit itself and specific hospital services.

Medicare Advantage (Part C) plans are an alternative to Original Medicare, offered by private insurance companies. These plans must cover at least what Original Medicare (Parts A and B) covers, including emergency services. While Medicare Advantage plans cover ER visits anywhere in the U.S., their specific cost-sharing rules, such as copayments and deductibles, can vary.