Medicare covers emergency room visits, but what you pay depends on which part of Medicare you have and whether the visit turns into a hospital stay.

If you have Original Medicare (Part A and Part B), Medicare pays its share of emergency room costs after you meet your deductible. You pay a copay — usually $185 for an ER visit — whether or not you are admitted to the hospital. If the ER visit leads to a hospital admission, that copay counts toward your hospital deductible, not a separate charge.

If you have a Medicare Advantage plan (Part C), your coverage works differently. Your plan sets its own copay for ER visits, which may be higher or lower than Original Medicare's $185. Some plans waive the copay if you are admitted to the hospital within a certain number of hours. Check your plan documents or call the member services number on your card to know your exact copay before you go.

Medicare does not cover the full cost of an ER visit. You are responsible for your deductible, copay, and any costs above what Medicare considers reasonable. If you have a Medigap policy or Medicaid, those programs may cover some or all of what Medicare does not pay.

Key Takeaways

  • Original Medicare covers ER visits after you pay a $185 copay, which counts toward your hospital deductible if you are admitted.
  • Medicare Advantage plans set their own ER copays, which vary by plan and may be waived if you are admitted within a set timeframe.
  • You are responsible for your deductible and any charges above Medicare's approved amount, even after Medicare pays its share.
  • Medigap or Medicaid coverage may reduce what you owe out of pocket for an ER visit.
  • Out-of-network ER visits are covered by Original Medicare, but Medicare Advantage plans may charge more if you use an out-of-network facility.

How Original Medicare Pays for Emergency Room Care

With Original Medicare, the ER visit itself is covered under Part B. You pay your Part B deductible (which is $240 in 2024, though this amount changes yearly) if you have not met it yet that year. After you meet the deductible, Medicare pays 80 percent of the approved amount, and you pay the remaining 20 percent plus the $185 copay.

The $185 copay is separate from the 20 percent coinsurance. If the ER visit results in a hospital admission, the $185 copay is waived and counts toward your Part A hospital deductible instead. Your Part A deductible (which is $1,632 in 2024) applies to your hospital stay, not the ER visit itself.

If the ER doctor orders imaging, lab work, or other services during your visit, those are billed separately. Medicare covers these services at 80 percent after your deductible, the same as the ER visit itself. You pay 20 percent coinsurance on each service.

Medicare Advantage Coverage for Emergency Room Visits

Medicare Advantage plans must cover emergency room visits, but each plan decides its own copay amount. Some plans charge $100 to $300 per ER visit; others may charge more. A few plans charge no copay for ER visits. Your plan documents or member services line will tell you the exact amount.

Many Medicare Advantage plans waive the ER copay if you are admitted to the hospital within 24 hours of the ER visit. This means if you go to the ER and are admitted the same day or the next day, you do not pay the copay. If you are treated and released, you pay the full copay. Read your plan's summary of coverage to see whether your plan has this rule and what the timeframe is.

Medicare Advantage plans also have out-of-network rules. If you go to an ER outside your plan's network, you may pay more — sometimes significantly more. Emergency rooms are usually considered in-network regardless of location, but it is worth confirming with your plan before an emergency happens, if possible. Call the member services number on your card and ask whether all ER visits are covered in-network or whether some facilities charge higher copays.

What Happens If You Are Admitted to the Hospital

If your ER visit leads to a hospital admission, your costs shift from the ER copay to the hospital deductible. With Original Medicare, you pay your Part A deductible ($1,632 in 2024) for the first day of your hospital stay. Days 2 through 60 cost you $408 per day (in 2024). Days 61 through 90 cost $816 per day. After 90 days, you pay the full cost unless you have used lifetime reserve days.

With Medicare Advantage, your hospital costs depend on your plan. Most plans charge a copay per day of hospitalization, which may be $200 to $500 or more. Some plans cap your out-of-pocket costs for the year; once you reach that cap, the plan pays 100 percent of covered services for the rest of the year. Check your plan documents to understand your hospital costs.

The ER copay does not explore once you are admitted. Instead, your hospital deductible and daily copays take over. This is why some people with Medicare Advantage plans see the ER copay waived — the plan is moving you to hospital cost-sharing instead.

Out-of-Network Emergency Rooms and Coverage

Original Medicare covers emergency room visits at any hospital in the United States, whether the facility is in-network or out-of-network. You pay the same $185 copay and the same 20 percent coinsurance regardless of where you go. This is one of the main advantages of Original Medicare — you have freedom to go to any ER without worrying about network restrictions.

Medicare Advantage plans are required to cover out-of-network emergency room visits at the in-network cost-sharing level. This means you should pay the same copay whether the ER is in your plan's network or not. However, some plans charge higher copays for out-of-network facilities, and the rules can be complex. If you are in an emergency, go to the nearest ER. After you recover, contact your plan to make sure you were charged correctly.

If you travel outside the United States, Medicare does not cover emergency room visits in other countries. Some Medicare Advantage plans offer limited coverage for emergencies abroad, but Original Medicare does not. If you travel internationally, consider a travel health insurance policy that covers emergency care.

Costs You May Not Expect

The ER copay covers the emergency room facility and the physician's evaluation, but other services billed during your visit are separate charges. If the ER doctor orders blood work, X-rays, CT scans, or an EKG, each of these is billed as its own service. With Original Medicare, you pay 20 percent coinsurance on each service after your deductible. With Medicare Advantage, your plan may charge a separate copay for imaging or lab work, or it may bundle these into the ER copay — check your plan documents.

If the ER doctor refers you to a specialist or admits you for observation (not a full hospital admission), costs can vary. Observation stays are sometimes billed under Part B rather than Part A, which means different cost-sharing rules explore. Ask the hospital billing department whether you are being admitted as an inpatient or placed in observation, because this affects what you owe.

Ambulance rides to the ER are covered by Medicare Part B if medically necessary, but you pay 20 percent coinsurance after your deductible. If you call an ambulance, Medicare covers it. If a family member drives you, there is no charge from Medicare, but you still pay the ER copay.

How to Reduce What You Pay for Emergency Care

If you have a Medigap policy, it may cover the $185 ER copay and the 20 percent coinsurance you owe. Medigap plans vary in what they cover, so check your policy or call your Medigap insurer to confirm. Some Medigap plans cover the full copay; others cover part of it.

If you have Medicaid in addition to Medicare, Medicaid may pay the copay and coinsurance. Medicaid rules vary by state, so contact your state Medicaid office or your local Area Agency on Aging to learn what Medicaid covers for ER visits.

If you cannot afford the copay or coinsurance, ask the hospital's financial information office about payment plans or charity care programs. Many hospitals have programs to help uninsured and underinsured patients. You can also contact your State Health Insurance information Program (SHIP), which offers free counseling about Medicare costs. Call 1-877-839-2675 to find your local SHIP office.

Frequently Asked Questions

Do I have to pay the ER copay if I am not admitted?

Yes. With Original Medicare, you pay the $185 copay whether you are admitted or treated and released. With Medicare Advantage, you pay your plan's ER copay unless your plan waives it for admissions within a certain timeframe. If you are released, you pay the full copay.

What if the ER bills me for more than Medicare says is reasonable?

Original Medicare sets an approved amount for ER visits. The hospital cannot bill you for more than your copay and 20 percent coinsurance. If you receive a bill for more, contact Medicare at 1-800-MEDICARE. With Medicare Advantage, contact your plan's member services line.

Does Medicare cover ER visits for non-emergency problems?

Yes. Medicare covers ER visits regardless of whether your problem turns out to be an emergency. You pay the same copay whether you have a heart attack or a sprained ankle. The ER staff decides whether your condition warrants emergency care, not Medicare.

Can I use an urgent care center instead of the ER to save money?

Urgent care visits are covered by Medicare, and your copay may be lower than an ER copay. However, urgent care centers are not equipped for serious emergencies. If you think you may be having a heart attack, stroke, or other life-threatening emergency, go to the ER. For minor injuries or illnesses, urgent care may be a lower-cost option.

What if I go to the ER and then get transferred to another hospital?

You pay the ER copay at the first hospital. If you are transferred and admitted, your hospital deductible applies at the second hospital. Some hospitals have agreements to share costs, but you should ask the billing department at each facility what you owe.