Medicare Part B usually covers emergency room (ER) visits unless a doctor admits someone to the hospital for a certain length of time.

For inpatient admissions, Medicare Part A may cover the ER visit and subsequent hospital stay if the length of the hospital admission spans at least 2 midnights.

This article breaks down how Medicare divides costs for ER visits, including different coverage scenarios.

Glossary of Medicare terms

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
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Medicare plans consist of different parts that account for various areas of healthcare. These parts cover various aspects of emergency care.

ER visits may involve treatment for acute injuries, sudden illnesses, or potentially life threatening conditions, including heart attack and stroke.

Medicare Part A

Medicare Part A provides hospital coverage. If a doctor admits an individual to the hospital for at least 2 midnights, Medicare Part A covers hospital services, such as accommodation costs and testing, while the person stays in the facility.

If Medicare Part A pays for the hospital visit, a person is responsible for a deductible of $1,632.

Once the individual spends this amount out of pocket on treatment, Medicare Part A pays 100% of the hospital costs for up to 60 days.

A person with Medicare Part A may also have to pay copayments for the medical services that they receive.

Medicare Part B

Medicare Part B is the portion of Medicare that most often covers ER visits if the doctor does not request inpatient admission.

When Medicare Part B covers the ER visit, a person is usually responsible for a portion of the costs. Examples of these costs include:

  • a copayment for the emergency department visit and hospital services
  • covering 20% of the funds that Medicare approves for doctor’s services
  • the Part B deductible

These copayments and deductibles may vary on a yearly basis.

Medicare Advantage

Medicare Advantage (Part C) is a bundled plan that includes Parts A, B, D, and some additional services that depend on the plan that a person chooses.

Private insurance companies offer Medicare Advantage plans. These plans cover the costs of an ER visit in a way similar to how Original Medicare covers them.

However, a Medicare Advantage plan may structure the billing and costs differently than Original Medicare. For example, the plan may ask someone to pay one copayment per visit that accounts for both the emergency room and the doctor.

Medicare Part D

Medicare Part D is a Medicare plan that provides coverage for prescription medications.

If an individual receives medications in the ER, Medicare Part D may pay for them if they are on the person’s list of covered medications.


Medigap, or Medicare supplement insurance, policies may provide emergency health coverage if a person is traveling outside the United States.

Traditional Medicare does not traditionally cover costs for emergency care if someone is traveling outside the country.

Only certain Medigap policies cover this cost, so people who travel frequently can compare various plans to choose the one that best suits their needs.

Sometimes, a blend of Medicare Parts A and B will cover aspects of an ER visit. The following are some example scenarios:

Scenario 1

Scenario: An ambulance brought you to the ER.

What pays: Medicare Part B generally covers ambulance transportation to a hospital, skilled nursing facility, or critical access hospital. The ambulance service will take you to the nearest appropriate medical facility, depending on your symptoms.

However, if you call the ambulance in a nonemergency situation, or the ambulance service believes that Medicare may not cover your ambulance trip, they will provide you with a notice called an “Advance Beneficiary Notice of Noncoverage.”

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Scenario 2

Scenario: You go to the hospital for severe abdominal pain. The first night, you are at the hospital under “observation,” and then the doctor decides to admit you to the hospital the next day.

What pays: Part A will cover your inpatient hospital stay and the services you received in the 3 days before your hospital admission. However, Part B will pay for the doctor’s services while you are in the hospital.

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Scenario 3

Scenario: You are in the ER, and a doctor writes an order to admit you to the hospital.

What pays: Part A will pay for your hospital stay and the services that you received when you were an outpatient. However, Part B will pay for your doctor’s services.

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It is important to remember that staying overnight at an ER does not automatically qualify someone as an inpatient.

The hospital or freestanding emergency department should confirm during the visit whether or not they are providing treatment on an inpatient basis. If a person is not an inpatient, Part B is the insurance portion that covers the services.

In a 2018 study of Medicare beneficiaries who were 65 years of age or older and sought treatment at an ER, the authors estimated that the treatment broke down in the following ways:

  • Doctors discharged 48% of people.
  • Doctors kept 10.5% of people in for observation.
  • The facility admitted 41.5% of people as inpatients.

According to the study, the most common reasons for hospital admission were ischemic heart disease and renal disease.

Very little data is available relating specifically to the ER expenses of Medicare beneficiaries. However, the overall average cost of an ER visit in 2019 was $1,917, according to the Healthcare Financial Management Association.

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

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Medicare plans have different parts that cover various emergency room services. Unless a doctor admits a person to the hospital, Part B will generally cover most emergency room (ER)-related costs.

When a person seeks ER care, they can ask for an estimate of service costs at any time, including charges for testing or doctor consultation fees.

Doing this may help reduce the stress of an ER visit and set expectations as to the out-of-pocket costs for their treatment.