Does Medicare Pay for Emergency Room Visits?

Medicare, a federal health insurance program, provides coverage for millions of Americans, primarily those aged 65 or older and certain younger individuals with disabilities. Understanding how Medicare handles emergency medical situations is important for managing healthcare needs and associated costs, including covered services and financial responsibilities.

Medicare Coverage for Emergency Services

Medicare generally covers emergency room visits when a medical condition requires immediate attention due to injury, sudden illness, or rapidly worsening illness. This coverage applies to any Medicare-participating emergency room or hospital across the United States. An emergency is defined as a condition that could place health in serious jeopardy without prompt medical intervention.

The specific Medicare part that covers an emergency room visit depends on whether the patient is admitted to the hospital. If a beneficiary receives emergency room services and is then formally admitted as an inpatient to the same hospital for a related condition, Medicare Part A (hospital insurance) typically covers the emergency room visit as part of the inpatient stay. However, if the individual is treated in the emergency room and not admitted as an inpatient, Medicare Part B covers the outpatient emergency services. This includes physician services, diagnostic tests like X-rays, and other outpatient hospital services. Medicare Advantage Plans, offered by private companies, must cover emergency services at a level at least equivalent to Original Medicare, and they must cover emergency care regardless of network status.

Your Financial Responsibility for Emergency Care

Beneficiaries often incur out-of-pocket costs for emergency room visits under Medicare, and these costs vary based on whether the visit results in an inpatient admission. For emergency room services treated on an outpatient basis, Medicare Part B covers the care. Patients are responsible for the annual Part B deductible ($257 in 2025). After meeting this, beneficiaries typically pay a copayment for the emergency department visit, another copayment for hospital services, and a 20% coinsurance for doctor services.

If the emergency room visit leads to a formal inpatient admission, Medicare Part A coverage applies, and the separate emergency room copayments typically do not apply. The beneficiary is responsible for the Medicare Part A deductible, which is $1,676 per benefit period in 2025. A “benefit period” begins the day a patient is admitted as an inpatient and ends when they have been out of the hospital or skilled nursing facility for 60 consecutive days.

Observation Status

A common scenario involves “observation status,” where a patient remains in the hospital for monitoring but is not formally admitted as an inpatient. Care under observation status is considered outpatient care, falling under Medicare Part B, which means the Part B deductible and 20% coinsurance for all services apply. Time spent under observation status does not count toward the three-day inpatient hospital stay requirement for Medicare coverage of skilled nursing facility care. Beneficiaries have the right to ask hospital staff about their admission status and should receive a Medicare Outpatient Observation Notice (MOON) if they are under observation for more than 24 hours.

Understanding Emergency Room vs. Urgent Care

Deciding where to seek medical attention is an important consideration, as emergency rooms and urgent care centers serve distinct purposes and have different cost implications. Emergency rooms are equipped to handle severe, life-threatening conditions such as heart attacks, strokes, severe bleeding, major injuries, or difficulty breathing, providing immediate care 24 hours a day. These facilities have a broad range of specialists and advanced diagnostic capabilities to manage complex medical emergencies.

In contrast, urgent care centers are suitable for non-life-threatening conditions that require prompt attention but are not severe enough to warrant an emergency room visit. These may include minor cuts requiring stitches, sprains, fevers, flu symptoms, minor infections, or sore throats. Urgent care centers generally offer extended hours and can provide services like X-rays and lab tests.

Medicare Part B covers urgent care visits, meaning the Part B deductible and 20% coinsurance apply. Generally, urgent care visits are less expensive and may involve shorter wait times compared to emergency room visits for similar non-emergency conditions. Choosing the appropriate facility can help manage healthcare costs and ensure timely access to the right level of care.