Going to the emergency room (ER) can be stressful. To give you some peace of mind, let’s review what Medicare covers for ER visits.
Part B usually covers 80% of ER services when you have an injury, a sudden illness or an illness that gets worse quickly.1
If Part B does pay some of the ER costs, you still pay:2
- A copayment for each ER visit
- A copayment for each hospital service
- 20% of the Medicare-approved amount for your doctor’s services
- The Part B deductible ($203 in 2021)
Original Medicare Part A (hospital insurance)
ER visits are considered outpatient stays, and Part A does not cover outpatient stays. However, if you’re formally admitted to the hospital with a doctor’s order, Part A will help pay for your inpatient hospital stay. It will also pay for related outpatient services provided during the 3 days before your admission date.3
Note: You’ll still be responsible for your deductible, coinsurance and copayments.
Medicare Part C (Medicare Advantage plans)
At a minimum, Medicare Advantage plans offer the same ER coverage as Original Medicare (Parts A and B). But, some Medicare Advantage plans may offer extra coverage for ER visits. If you get your Medicare coverage through a Medicare Advantage plan, check with your provider for details.4
Note: You’ll still be responsible for your deductible, coinsurance, copayments and your Medicare Advantage plan monthly premium.
Medicare Part D (prescription drug plans)
Part D helps pay for prescription medications. If you have a prescription drug plan and receive medication in the ER that’s on your list of covered medications, Part D may help pay for it.5
Medicare Supplement plans (Medigap)
Medicare Supplement plans help cover out-of-pocket expenses for Original Medicare. Some Medigap plans pay for all or part of Part B’s coinsurances or copayments, which can lower the costs of an ER visit. If you have a Medigap plan, check with your provider for details.6
For more helpful information on Medicare, check out these 10 frequently asked questions about Medicare plans.