Does Medicare Part A Pay for Emergency Room Visits?

Medicare Part A is the federal hospital insurance program, covering inpatient care in hospitals, skilled nursing facilities, hospice care, and certain home health services. This article clarifies how Medicare Part A applies to emergency room visits, detailing its coverage and costs.

Medicare Part A Coverage for Emergency Services

Medicare Part A covers facility costs when an emergency room visit leads to a formal inpatient hospital admission. If a doctor admits a patient to the hospital after an emergency, Part A helps pay for the hospital stay, including the room, meals, nursing services, and other hospital-provided services and supplies. This coverage is triggered by the inpatient admission order, recognizing the patient’s need for ongoing hospital care.

If an emergency room visit does not result in a formal inpatient admission, Part A does not cover the emergency department’s facility charges. This applies even if the patient spends several hours in the emergency room receiving treatment, diagnostic tests, or observation. In such cases, the patient is considered an outpatient, and other parts of Medicare are responsible for the costs.

A benefit period for Medicare Part A begins the day a patient is admitted as an inpatient to a hospital or skilled nursing facility. This period ends when the patient has been out of the facility for 60 consecutive days. If a patient is readmitted after this 60-day period, a new benefit period begins, and a new deductible may apply.

Role of Medicare Part B in Emergency Care

Medicare Part B covers emergency care, especially for services not covered by Part A. Part B covers physician services received in the emergency room, such as fees charged by the emergency physician, surgeons, or other specialists. This coverage applies regardless of whether the patient is admitted as an inpatient or remains an outpatient.

Part B also covers outpatient hospital services, including diagnostic tests like X-rays, MRIs, and laboratory work performed in the emergency department. Supplies and medications administered in the emergency room that are not part of an inpatient admission are covered under Part B.

After the annual deductible is met, Part B pays 80% of the Medicare-approved amount for covered services. The patient is responsible for the remaining 20% coinsurance. This means that even if Part A covers facility costs due to an inpatient admission, Part B still covers the professional fees of the doctors involved in the emergency care.

Understanding Costs for Emergency Care

Medicare beneficiaries can face out-of-pocket costs for an emergency room visit, depending on the services received and admission status. If an emergency room visit results in a formal inpatient hospital admission, the Medicare Part A deductible applies. For 2025, this deductible is $1,676 per benefit period. Once met, Part A covers the full cost of the inpatient hospital stay for the first 60 days of a benefit period.

Should the inpatient stay extend beyond 60 days, daily coinsurance amounts apply under Part A. From day 61 through day 90 of a benefit period, the coinsurance is $419 per day in 2025. For days 91 and beyond, beneficiaries can use their lifetime reserve days, which incur a coinsurance of $838 per day in 2025.

For emergency services covered by Medicare Part B, such as physician fees and outpatient hospital services, an annual deductible applies. The 2025 Medicare Part B annual deductible is $257. After meeting this deductible, beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount for most Part B services.

Admission Status and Its Impact on Coverage

The status assigned to a patient by a doctor in an emergency setting impacts how Medicare covers services and the beneficiary’s resulting costs. Being admitted as an “inpatient” means a doctor has issued an order for inpatient admission, indicating the patient requires a hospital stay that crosses at least two midnights. When this occurs, Medicare Part A covers the facility costs of the hospital stay, including the emergency room charges that led to the admission. This status triggers the Part A deductible and any applicable inpatient coinsurance.

Conversely, if a patient is placed under “observation status,” they are in the hospital but are still considered an outpatient, regardless of how long they remain. In this scenario, Medicare Part B covers all services, including emergency room facility charges, physician services, and diagnostic tests. Observation status does not trigger Part A coverage for facility costs, and the patient is responsible for Part B deductibles and coinsurance for all services received. Out-of-pocket costs can be higher under observation status compared to a formal inpatient admission, especially for extended stays.

Patients who are treated and released from the emergency room are also considered “outpatients.” For these individuals, Medicare Part B covers physician services and all other outpatient services received in the emergency department. The doctor’s order regarding admission status directly determines whether Part A or Part B pays for the hospital facility portion of the visit. This decision directly influences the beneficiary’s financial responsibility.