What Medicare Part B Covers When You Go to the Emergency Room

Medicare Part B covers emergency room visits, but you pay a share of the cost

Yes, Medicare Part B covers emergency room visits. When you go to an emergency room, Part B pays its share of the bill after you meet your deductible. You will owe a copay or coinsurance — the amount depends on whether the hospital keeps you overnight and what services you receive in the ER.

The key thing to understand is that Part B covers the doctor's evaluation and treatment in the emergency room itself. If the ER doctors decide you need to be admitted to the hospital, Part A (hospital insurance) takes over for your inpatient stay. If they treat you and send you home, Part B is what pays.

Your out-of-pocket cost for an ER visit is not the same as your office visit copay. Emergency room visits have their own cost-sharing rules, and the amount you owe can be substantial if you have not yet met your deductible for the year.

Key Takeaways

Medicare Part B covers the cost of emergency room evaluation and treatment after you pay your annual deductible and your share of the bill.
You will owe coinsurance (usually 20% of the Medicare-approved amount) for emergency room services, not a flat copay like you would for an office visit.
If the hospital admits you after the ER visit, Part A coverage begins and your ER copay does not count toward your hospital deductible.
Out-of-network emergency rooms are covered the same way as in-network ones, so you can seek emergency care anywhere without worrying about network status.
Medigap or Medicare Advantage plans may cover some or all of your ER copay or coinsurance, depending on your plan.

How much you pay for an emergency room visit

Your cost for an emergency room visit depends on whether you have met your Part B deductible for the year. For 2024, the Part B deductible is $240. Once you pay that deductible, you owe 20% coinsurance for emergency room services — meaning Medicare pays 80% and you pay the remaining 20% of the Medicare-approved amount.

The Medicare-approved amount is not the same as the hospital's full charge. Medicare sets what it will pay for each service, and that is the amount used to calculate your 20%. If the hospital charges more than Medicare's approved amount, you do not owe the difference — that is called balance billing protection, and it applies in emergency situations.

If you have not yet met your $240 deductible when you go to the ER, you pay the full deductible first, then your 20% coinsurance on top of that. This means your bill can be several hundred dollars depending on what services the ER provides.

What happens if you are admitted to the hospital

If the emergency room doctors decide you need to be admitted as an inpatient, your coverage switches from Part B to Part A at the moment of admission. Your Part B coinsurance for the ER visit does not carry over or count toward your Part A hospital deductible — they are separate.

Part A has its own deductible ($1,632 for 2024) and its own cost-sharing rules for hospital stays. The ER visit bill and the hospital stay bill are handled separately, so you may owe money for both. This is one reason it is important to ask the hospital billing department to explain your costs before you leave.

Emergency room visits that turn out not to be emergencies

Medicare covers emergency room visits even if the doctors determine that your condition was not actually an emergency. You do not have to worry about Part B refusing to pay because the visit was unnecessary — as long as you reasonably believed you needed emergency care when you arrived, Medicare will cover it.

This protection exists because people cannot always know in advance whether chest pain, severe dizziness, or sudden weakness is serious. Medicare's rule is based on whether a reasonable person would have thought emergency care was needed, not on what the doctors found after examining you.

How Medigap and Medicare Advantage affect your ER costs

If you have a Medigap policy (also called Medigap supplement insurance), your plan may cover some or all of your Part B coinsurance for emergency room visits. Most Medigap plans cover the 20% coinsurance, though a few cover only part of it. Check your Medigap policy documents or call your insurance company to see what your plan covers.

If you have a Medicare Advantage plan, your emergency room coverage works differently. Advantage plans set their own copays and coinsurance amounts, which may be higher or lower than Original Medicare's 20%. Your plan documents will tell you exactly what you owe for an ER visit. Advantage plans also require you to use in-network providers when possible, but emergency rooms are an exception — you can go to any hospital's emergency room and receive in-network-level coverage.

Out-of-state and out-of-network emergency rooms

Medicare Part B covers emergency room visits at any hospital in the United States, regardless of whether the hospital is in your insurance network or in your home state. If you are traveling and need emergency care, you can go to the nearest emergency room without worrying about whether Medicare will cover it.

You pay the same coinsurance (20% after your deductible) whether the ER is in-network or out-of-network. This is one of the few situations where Medicare does not penalize you for using an out-of-network provider, because you cannot plan an emergency.

What to do before you leave the emergency room

Before you leave the emergency room, ask the billing department for an estimate of what you will owe. They can tell you whether you have met your deductible and calculate your coinsurance based on the services provided. Get this in writing if possible, so you have a record.

If you do not understand your bill after you receive it, call the hospital's billing department and ask them to explain each charge. You can also contact Medicare directly at 1-800-MEDICARE to ask whether a specific charge is covered or to report a billing problem.

Frequently Asked Questions

Do I need to call Medicare before going to the emergency room?

No. You do not need permission from Medicare to go to an emergency room. Go when ready if you believe you need emergency care. You can contact Medicare after you have received treatment to ask questions about your bill or coverage.

Will Medicare cover an emergency room visit if I go to an out-of-network hospital?

Yes. Emergency room visits are covered at any hospital, in-network or out-of-network, anywhere in the United States. You pay the same 20% coinsurance as you would at an in-network hospital after you meet your deductible.

What if the emergency room sends me home but I think I should have been admitted?

You have the right to request an inpatient admission if you disagree with the ER doctor's decision. If the hospital still refuses to admit you, you can file a complaint with Medicare or your state's health department. The decision to admit is ultimately the doctor's, but you can ask for a second opinion or seek care elsewhere.

Does my ER copay count toward my hospital deductible if I am admitted?

No. Part B (which covers the ER visit) and Part A (which covers the hospital stay) have separate deductibles. Your ER coinsurance does not reduce what you owe for your Part A hospital deductible. You may owe money for both.

What if I cannot pay my emergency room bill?

Contact the hospital's financial information office and ask about payment plans or financial hardship programs. Many hospitals offer reduced rates for people with low income or can spread your bill into monthly payments. Do not ignore the bill — working with the hospital is better than letting it go to collections.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.