Medicare covers emergency room visits, but what you pay depends on which type of Medicare you have and whether the ER visit is truly an emergency.

If you have Original Medicare (Part A and Part B), Medicare pays 80 percent of the cost of an emergency room visit after you meet your Part B deductible for the year. You pay the remaining 20 percent. If you are admitted to the hospital from the ER, the visit is covered under Part A (hospital insurance) instead, and you pay your Part A deductible.

If you have a Medicare Advantage plan (Part C), your coverage works differently. Each plan sets its own copay or coinsurance for ER visits — typically $150 to $500 — and you must use in-network hospitals unless it is a true emergency. After you pay your share, the plan covers the rest.

The key word is emergency. Medicare defines an emergency as a medical condition severe enough that a reasonable person would seek when ready care. If the ER determines your condition was not an emergency, you may owe the full bill. This happens most often when people go to the ER for non-urgent care that could have been handled at an urgent care center or doctor's office.

Key Takeaways

  • Original Medicare covers 80 percent of emergency room costs after your Part B deductible; you pay 20 percent.
  • Medicare Advantage plans charge a copay or coinsurance for ER visits, usually $150 to $500, and may require in-network hospitals.
  • Medicare only covers ER visits for true medical emergencies, not for routine or non-urgent care.
  • If you are admitted to the hospital from the ER, your Part A deductible applies instead of your Part B deductible.
  • If Medicare determines your ER visit was not an emergency, you may receive a bill for the full cost.

How Original Medicare Covers Emergency Room Costs

With Original Medicare, your Part B deductible must be met before Medicare starts paying. For 2024, that deductible is $240, though this amount changes each year. Once you have paid that amount out of pocket for Part B services in a calendar year, Medicare covers 80 percent of your ER bill and you cover 20 percent.

If your ER visit leads to a hospital admission, the bill shifts to Part A coverage instead. You would then pay your Part A deductible (which is separate from Part B) and a daily copay if your stay extends beyond 60 days. The ER visit itself is bundled into your hospital bill and is not charged separately.

Original Medicare does not require you to use any particular hospital or get prior approval for an ER visit. You can go to any hospital's emergency room in the United States, and Medicare will cover it as long as the visit meets the emergency standard.

How Medicare Advantage Plans Cover Emergency Room Visits

Medicare Advantage plans are required by federal law to cover emergency room visits even if you use an out-of-network hospital. However, your out-of-pocket cost is usually higher for out-of-network care. Most plans charge a copay of $150 to $500 for an ER visit, though some use coinsurance (a percentage of the bill) instead.

After you pay your copay or coinsurance, the plan covers the remaining cost. Unlike Original Medicare, you do not have a separate deductible for ER visits — your copay is your only out-of-pocket expense for that visit, unless the plan later determines it was not an emergency.

Check your plan's summary of coverage or call the plan directly to find out your exact copay amount. Copays vary widely between plans, and knowing your cost ahead of time helps you understand what to expect when you receive the bill.

What Counts as a Medical Emergency Under Medicare

Medicare defines an emergency as a medical condition with symptoms severe enough that a reasonable person would seek when ready care to avoid serious harm to health. This includes chest pain, difficulty breathing, severe bleeding, loss of consciousness, severe allergic reactions, and sudden severe pain.

It does not include conditions that could safely wait for a scheduled doctor's appointment or be treated at an urgent care center. If you go to the ER for a minor cut, a rash that has been present for days, or a mild cough, Medicare may not consider it an emergency.

The ER doctor's assessment matters, but it is not final. After your visit, Medicare or your Medicare Advantage plan reviews the medical record to determine whether the condition truly was an emergency. If the review concludes it was not, you receive a notice and may owe the full cost of the visit.

What Happens if Medicare Says Your ER Visit Was Not an Emergency

If Medicare or your plan determines your ER visit was not an emergency, you will receive a written notice explaining the decision. You have the right to ask for a review of that decision, called an appeal. The appeal process is different for Original Medicare and Medicare Advantage plans.

With Original Medicare, you can request a redetermination within 120 days of receiving the notice. With a Medicare Advantage plan, you can file a grievance or appeal through your plan. Both processes allow you to present additional medical information or explain why you believed the visit was urgent.

If you disagree with the decision and the appeal is denied, you are responsible for paying the bill. This is why it is important to go to the ER only for conditions that truly feel like emergencies — not to avoid a copay at urgent care or to get faster service than a doctor's office.

Urgent Care and Other Alternatives to the Emergency Room

If you have a medical concern that is not life-threatening but needs prompt attention, an urgent care center is usually a better choice than the ER. Urgent care visits are typically covered by Medicare at a lower copay than the ER, and you will be seen faster because urgent care does not handle life-threatening emergencies.

Your primary care doctor's office may also have same-day or next-day appointments for acute problems. Calling your doctor first, before heading to the ER, can help you figure out whether you truly need emergency care or whether another setting is appropriate.

Telemedicine visits are another option for non-emergency concerns. Many Medicare plans cover virtual visits with doctors, and these can often be scheduled within hours. If the doctor determines you need in-person care, they can direct you to the right setting.

Costs You Should Know About

With Original Medicare, your 20 percent coinsurance can add up quickly if the ER bill is large. A typical ER visit costs $1,000 to $3,000 before insurance, meaning your 20 percent share could be $200 to $600. If you have a Medigap supplemental plan, it may cover some or all of that coinsurance.

With Medicare Advantage, your copay is fixed, so you know exactly what you will owe at the time of service. However, if the plan later denies the visit as non-emergency, you may receive a bill for the full cost weeks or months later.

Neither Original Medicare nor Medicare Advantage covers the cost of an ambulance ride to the hospital, though Medicare Part B does cover ambulance transport if it is medically necessary and ordered by a doctor. You will receive a separate bill for the ambulance.

Frequently Asked Questions

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

No. You should never delay emergency care to call Medicare or your insurance plan. Go to the ER when ready if you believe you are having a medical emergency. You can contact Medicare or your plan after you have received care to ask about coverage.

Will I owe money if I go to an out-of-network ER?

With Original Medicare, you will owe your usual 20 percent coinsurance regardless of whether the hospital is in-network. With Medicare Advantage, you may owe a higher copay for out-of-network care, but the plan must still cover emergency visits. Check your plan documents for the exact amount.

What if I go to the ER and it turns out I did not need emergency care?

You will still owe your copay or coinsurance at the time of service. If Medicare or your plan later determines the visit was not an emergency, you may receive a bill for the remaining cost. You can appeal this decision if you believe the visit was medically necessary.

Does Medicare cover the cost of an ambulance to the ER?

Medicare Part B covers ambulance transport if a doctor orders it and it is medically necessary. You will receive a separate bill for the ambulance. If you drive yourself or a family member drives you, there is no ambulance charge.

Can I use any hospital's emergency room with Medicare?

Yes, with Original Medicare you can use any hospital's ER in the United States. With Medicare Advantage, you should use in-network hospitals when possible to keep your copay lower, but the plan must cover out-of-network ERs for true emergencies.