Medicare covers emergency room visits, but what you pay depends on which part of Medicare you have and whether the hospital is in your plan's network

If you have Original Medicare (Part A and Part B), the emergency room visit itself is covered. Medicare Part B pays 80 percent of the cost after you meet your yearly deductible; you pay the remaining 20 percent. If you are admitted to the hospital through the emergency room, Part A covers your inpatient stay under hospital insurance rules.

If you have a Medicare Advantage plan (Part C), your coverage works differently. Most Advantage plans cover emergency room visits, but you typically pay a copay — often $100 to $250 — whether or not you are admitted. The exact amount depends on your specific plan. Emergency room visits are usually covered even if you go to an out-of-network hospital, because emergency care is considered an exception to network rules.

The key difference is this: Original Medicare covers the service itself; Medicare Advantage plans cover the service but charge you upfront. Neither covers the emergency room visit if you later find out there was no emergency — but that information is made by the hospital, not by you or Medicare.

Key Takeaways

  • Original Medicare Part B covers 80 percent of emergency room costs after your deductible; you pay 20 percent.
  • Medicare Advantage plans cover emergency room visits with a copay, usually $100 to $250, even at out-of-network hospitals.
  • If you are admitted to the hospital from the emergency room, Part A inpatient coverage begins; you pay a deductible but no copay for the hospital stay itself.
  • Urgent care centers and walk-in clinics are not the same as emergency rooms and may have different costs under your plan.

How Original Medicare Covers Emergency Room Visits

Under Original Medicare Part B, the emergency room visit is treated like any other outpatient service. After you pay your yearly Part B deductible (which is $240 in 2024, though this amount changes each year), Medicare pays 80 percent of what it considers the reasonable charge for the visit. You are responsible for the remaining 20 percent, called coinsurance.

The actual bill you receive depends on what the hospital charges and what Medicare determines is reasonable. If the hospital charges more than Medicare's approved amount, you do not pay the difference — the hospital must write it off. This is called balance billing protection, and it applies to all Medicare-participating hospitals.

If the emergency room visit leads to admission, your costs change. Once you are admitted as an inpatient, Part A takes over. You pay a single deductible for your hospital stay (which is $1,632 in 2024 for days 1 through 60), and then Medicare covers the rest. You do not pay per day or per service once admitted — you pay only the deductible, no matter how long you stay within the first 60 days.

How Medicare Advantage Plans Cover Emergency Room Visits

Medicare Advantage plans are required by federal law to cover emergency room visits at any hospital, whether in-network or out-of-network. This is one of the few services that cannot be restricted to network providers. You pay a copay at the time of service, and the plan covers the rest.

The copay amount varies by plan. Some plans charge $100; others charge $250 or more. Check your plan's summary of benefits or call the plan directly to find your exact copay. If you are unsure which plan you have, your Medicare card will say "Medicare Advantage" or show a plan name like Humana, UnitedHealthcare, or Aetna.

If you are admitted to the hospital from the emergency room, the copay you paid at the emergency room does not count toward your hospital deductible. Most Advantage plans have a separate inpatient deductible, which you would then pay when admitted. Some plans waive the inpatient deductible if you are admitted through the emergency room, so check your plan documents or call to confirm.

What Happens If You Go to an Out-of-Network Hospital

With Original Medicare, there is no such thing as an out-of-network hospital. Medicare is accepted at any hospital that participates in Medicare, which includes nearly all hospitals in the United States. You can go to any emergency room, and Medicare covers it the same way.

With Medicare Advantage, out-of-network emergency rooms are covered at the in-network copay rate. You do not pay extra for going out-of-network in an emergency. However, if you are admitted and transferred to an in-network hospital, your Advantage plan may cover the transfer. If you choose to stay at the out-of-network hospital after the emergency is stabilized, you may face higher costs or may have to pay the full bill yourself — this depends on your specific plan.

The Difference Between Emergency Room, Urgent Care, and Walk-In Clinics

Medicare and Medicare Advantage plans treat these three settings differently, and the cost to you can vary widely. An emergency room is part of a hospital and is open 24 hours for life-threatening or serious injuries. An urgent care centerwalk-in clinic is similar to urgent care but may have even shorter hours and handle only minor issues.

Under Original Medicare, urgent care and walk-in visits are covered as outpatient services, just like the emergency room, and you pay 20 percent coinsurance after your deductible. Under Medicare Advantage, urgent care and walk-in visits usually have a lower copay than the emergency room — often $30 to $50 — because they are not emergencies. If you go to the emergency room for something that could have been handled at urgent care, you still pay the emergency room copay, so choosing the right setting can save you money.

What You Need to Bring to the Emergency Room

Bring your Medicare card and any other insurance cards you have. If you have Original Medicare, bring your red, white, and blue card. If you have Medicare Advantage, bring your plan card, which usually has a different color and design. If you have both Original Medicare and a Medigap supplemental plan, bring both cards.

The hospital will ask for your identification and insurance information when you arrive. If you do not have your card, tell the staff your Medicare number — it is on your card, but the hospital can look it up by your Social Security number and date of birth. Do not delay seeking emergency care because you do not have your card with you. Hospitals are required to treat you regardless of whether you can show proof of insurance at that moment.

What Is Not Covered in the Emergency Room

Medicare covers the emergency room visit and the medical services provided there — the doctor's exam, tests, imaging, medications given in the emergency room, and any procedures performed. What Medicare does not cover includes ambulance transport (unless medically necessary and pre-approved), experimental treatments, and services deemed not medically necessary by the hospital or Medicare.

If the emergency room determines that you did not have a true emergency — for example, you came in for a minor issue that could have waited — Medicare may deny the claim. This is rare, and the hospital makes this information, not Medicare. If your claim is denied, you have the right to appeal. Original Medicare and Medicare Advantage plans both have appeal processes, and you can request a review if you believe the denial was wrong.

Frequently Asked Questions

Do I have to pay the emergency room copay upfront, or can I pay later?

With Medicare Advantage, most hospitals ask for your copay at the time of service or shortly after. If you cannot pay when ready, ask the billing department about a payment plan. With Original Medicare, you typically do not pay anything at the emergency room — you receive a bill later after Medicare processes the claim and you pay your 20 percent coinsurance.

What if I go to the emergency room and they say it was not a real emergency?

This is uncommon. The hospital, not Medicare, decides whether an emergency existed based on your symptoms and condition when you arrived. If Medicare denies your claim, you can appeal. You have the right to request a review, and you can ask for help from a patient advocate at the hospital or from your state's Medicare ombudsman.

Does my Medigap plan help pay the 20 percent coinsurance after the emergency room?

Yes. If you have Original Medicare and a Medigap supplemental plan, Medigap typically covers some or all of the 20 percent coinsurance you would otherwise pay. Check your Medigap plan documents to see what percentage it covers. Medigap does not work with Medicare Advantage plans.

If I am admitted to the hospital from the emergency room, do I pay both the emergency room copay and the hospital deductible?

With Original Medicare, you pay the Part B deductible (if you have not met it) for the emergency room visit, and then you pay the Part A deductible for the hospital stay. These are separate. With Medicare Advantage, you pay the emergency room copay and then the inpatient deductible, though some plans waive the inpatient deductible if you are admitted through the emergency room.

Can I use my Medicare card at any hospital emergency room?

Yes, with Original Medicare. Nearly all hospitals in the United States accept Medicare. With Medicare Advantage, you can use any hospital in an emergency, but if you are admitted and stay, confirm with your plan whether the hospital is in-network to avoid higher costs later.