Does Medicare Pay for Emergency Room Visits?
Understand Medicare's coverage for emergency room visits, including what's covered, your out-of-pocket costs, and how different plans apply.
Medicare, the federal health insurance program, provides coverage for millions of Americans, primarily individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. Understanding Medicare coverage for emergency services is important due to their unpredictable and often costly nature. Knowing how Medicare processes these claims helps manage potential financial obligations.
Medicare Part A and Part B Coverage for Emergency Visits
Original Medicare (Part A and Part B) covers emergency room visits. The specific coverage depends on whether the individual is formally admitted to the hospital. Medicare Part B generally covers services received in an emergency room if the individual is treated and then released, or held for observation. This includes physician services, diagnostic tests, and facility fees for outpatient emergency care.
If an emergency room visit leads to an inpatient hospital admission, Medicare Part A becomes the primary payer for the hospital stay. This transition occurs when a doctor formally admits the patient for further care after the initial emergency assessment. An emergency medical condition is one a prudent layperson would expect to cause serious health jeopardy, significant bodily function impairment, or severe organ or body part dysfunction if immediate medical attention is not received.
Your Financial Responsibility for Emergency Care
When receiving emergency care under Original Medicare, beneficiaries typically incur out-of-pocket costs. For services covered under Medicare Part B, an annual deductible applies. In 2025, the Medicare Part B annual deductible is $257. After this deductible is met, individuals are generally responsible for 20% of the Medicare-approved amount for physician and other outpatient services received in the emergency room. The emergency room facility services may also involve a copayment.
If the emergency visit results in an inpatient hospital admission, financial responsibility shifts to Medicare Part A. For 2025, the Medicare Part A inpatient hospital deductible is $1,676 per benefit period. This deductible covers the first 60 days of a Medicare-covered inpatient hospital stay. For longer stays, a daily coinsurance applies: $419 per day for days 61 through 90, and $838 per day for lifetime reserve days beyond day 90.
How Other Medicare Plans Affect Emergency Coverage
Medicare Advantage Plans (Part C) offer an alternative to Original Medicare and must cover all the same services as Parts A and B, including emergency care. These plans, offered by private insurance companies, often have different cost-sharing structures, such as varying copayments, deductibles, and out-of-pocket maximums for emergency room visits. Medicare Advantage plans must cover emergency care regardless of whether the facility is within the plan’s network.
Medigap policies (Medicare Supplement Insurance) work with Original Medicare to help cover some of the out-of-pocket costs that Original Medicare does not. These policies can help pay for deductibles, copayments, and coinsurance amounts for emergency room visits. Different Medigap plans offer varying levels of coverage for these expenses, helping reduce the financial burden associated with emergency care.
Coverage for Related Emergency Services
Medicare Part B also covers ambulance services when medically necessary, meaning transportation by other means would endanger the individual’s health. This coverage applies to transport to the nearest appropriate medical facility. After the Part B deductible is met, beneficiaries typically pay 20% of the Medicare-approved amount for ambulance services. Limited coverage may also be available for non-emergency ambulance transport if specific medical conditions are met and a physician certifies the necessity.
Observation stays, which can occur in a hospital bed for monitoring purposes, are considered outpatient services and are covered under Medicare Part B. Even if an individual stays overnight, if they are under observation status and not formally admitted as an inpatient, services are billed under Part B. Costs for observation stays involve the Part B deductible and coinsurance, meaning beneficiaries pay 20% of the Medicare-approved amount for services received. Observation time does not count toward the three-day inpatient hospital stay requirement for Medicare coverage of skilled nursing facility care.