Does Medicare Part A Cover ER Visits?

Medicare Part A is a component of the federal health insurance program for individuals aged 65 or older, and certain younger people with disabilities. It primarily functions as hospital insurance, raising common questions about its coverage for emergency room visits. This article clarifies the distinctions and coverage rules surrounding emergency room care under Medicare.

Medicare Part A Coverage Basics

Medicare Part A provides coverage for inpatient hospital stays, including semi-private rooms, meals, general nursing, and other hospital services and supplies. It also extends to skilled nursing facility care, hospice care, and some home health services.

The coverage under Medicare Part A is specifically designed for situations requiring formal admission to a medical facility. Not all medical services received within a hospital setting, such as an emergency room, automatically fall under Part A. The type of care received and the patient’s official status determine which part of Medicare applies.

Emergency Room Visit Classification

A hospital’s classification of an emergency room visit significantly impacts Medicare coverage. An ER visit can lead to different outcomes: a formal inpatient admission, placement under “observation status,” or treatment and direct discharge.

Inpatient admission occurs when a doctor formally orders a patient admitted to the hospital, anticipating a stay of at least two midnights. This means the patient requires continuous hospital care. Conversely, “observation status” is an outpatient service, even if the patient remains in a hospital bed, where doctors monitor their condition to determine if inpatient admission is necessary. The hospital’s decision on inpatient or outpatient status affects Medicare billing.

How Medicare Parts A and B Apply to ER Visits

Medicare Part A covers hospital costs for an emergency room visit only if it results in a formal inpatient admission. If a doctor admits a patient to the hospital after an ER visit, Part A helps pay for the hospital facility charges. This coverage is for the inpatient stay itself, not for the initial emergency room services that led to the admission.

Medicare Part B, which is medical insurance, covers emergency room services if the visit results in “observation status” or if the patient is treated and discharged without formal inpatient admission. Part B also covers other medical services received in the ER, such as physician services. Additionally, ambulance services to and from the hospital are covered under Medicare Part B, regardless of whether the ER visit leads to an inpatient admission or observation status.

Your Financial Responsibility

Your financial responsibility for emergency room visits under Medicare involves various potential costs. If an emergency room visit leads to a formal inpatient admission, Medicare Part A applies, and you will be responsible for the Part A deductible. For 2025, the Medicare Part A deductible is $1,676 per benefit period. A new benefit period begins after you have been out of a hospital or skilled nursing facility for 60 consecutive days.

If your ER visit results in “observation status” or you are treated and discharged, Medicare Part B covers these services. You will need to meet the annual Medicare Part B deductible, which is $257 in 2025. After meeting the Part B deductible, you pay 20% of the Medicare-approved amount for most Part B-covered services, known as coinsurance. This 20% coinsurance applies to outpatient ER care, observation stays, and physician fees.