Medicare covers emergency room visits within the United States and its territories. Out-of-pocket costs differ between original Medicare and Medicare Advantage plans.
In most cases, Medicare does not cover emergency room visits for people traveling in a foreign country. However, Medigap, which is Medicare supplemental insurance, has some plans that offer this benefit.
This article discusses coverage of emergency room visits with original Medicare (Part A and Part B) and Medicare Advantage plans. It also explains inpatient and outpatient costs, examines Medicare and Medigap coverage of emergency room visits in a foreign country, and looks at Medicare coverage of urgent care.
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.
Below are details on how original Medicare and Medicare Advantage cover emergency room visits:
Original Medicare comprises Part A, which is hospital insurance, and Part B, which is medical insurance. Part B covers an emergency room visit, including doctor services, medical tests, and intravenous medications.
If a person gets a prescription before leaving the emergency room, neither Part A nor Part B covers it. To get this coverage, a person enrolled in original Medicare must have Part D, which covers prescription drugs.
Sometimes, when people visit an emergency room, a doctor will write an order to admit them to the hospital. On these occasions, Part A covers the services that an individual receives in the emergency room prior to their admission.
In addition, Part A covers all the services that people receive during a hospital admission, including prescription drugs. The only exception to this is doctor services, which fall under Part B.
Medicare Advantage (Part C) is the alternative to original Medicare and provides all the same benefits. Advantage plans cover emergency room visits, but the rules of coverage and out-of-pocket costs differ from those of original Medicare. Coverage and costs also vary among plans.
Many Advantage plans require a person to use in-network providers, but insurance providers generally waive this regulation for emergency room visits.
The costs of emergency room visits depend on whether a person is there as an outpatient or an inpatient.
People have outpatient status if the emergency room discharges them to return home on the day of their visit. They also have outpatient status if they stay overnight in the hospital for observation because Medicare considers a person an outpatient unless a doctor writes an order to admit them. Part B covers outpatient costs.
When a person visits an emergency room, and a doctor writes an order to admit them to the hospital, they have inpatient status. This status means that Part A covers their costs. Generally, the out-of-pocket costs include the $1,408 deductible (in 2020) and $0 coinsurance for days 1–60.
In addition to the 50 U.S. states, original Medicare and Medicare Advantage cover an emergency room visit in U.S. territories, including:
- Puerto Rico
- Northern Mariana Islands
- U.S. Virgin Islands
- American Samoa
The two Medicare programs cover emergency room visits outside U.S. territories only in the following rare circumstances:
- A person has a medical emergency in the U.S., but a foreign hospital is closer than a U.S. hospital.
- Someone has a medical emergency when traveling in Canada between Alaska and another state, and a Canadian hospital is closer than a U.S. hospital.
- An individual living in the U.S. needs medical attention in a hospital, and the nearest one is in a foreign country.
Medigap, which is a Medicare insurance supplement, is available only for people enrolled in original Medicare. A person with a Medicare Advantage plan is not eligible to enroll in Medigap.
Medigap pays 50–100% of the out-of-pocket costs of Medicare parts A and B, including those for U.S. emergency room visits.
In addition, some Medigap plans offer coverage of foreign emergency room visits. This area of coverage is broader than the limited coverage of original Medicare and Medicare Advantage.
A requirement for coverage is that the emergency care must begin during the first 60 days of a person’s trip. The coverage has a lifetime limit of $50,000. Out-of-pocket expenses in 2020 include a $250 annual deductible and 20% of billed charges for medically necessary emergency care.
Medigap plans C, D, F, G, M, and N offer the benefit. Although plans E, H, I, and J are no longer available for purchase, a person with one of these plans also gets foreign emergency care coverage.
At times, someone may need a doctor’s attention quickly despite their illness or injury not being a medical emergency. Original Medicare covers a visit to urgent care in the same way that it covers an emergency room visit. Coverage falls under Part B. The 2020 costs include 20% coinsurance, and the $198 deductible applies.
Advantage plans also cover urgent care, but, as with emergency room visits, the costs differ among plans.
In original Medicare, the coverage of emergency room visits falls under Part B. The costs include a 20% coinsurance after paying the annual deductible of $198. If an emergency room visit leads to an admission to the hospital, the costs fall under Part A and include a $1,408 deductible and $0 coinsurance for days 1–60.
The coverage and costs of Advantage plans for emergency room visits differ from those of original Medicare. As they also vary widely among plans, a person may wish to contact their plan provider to check coverage and out-of-pocket costs.
We will update the 2021 costs as soon as possible after the Centers for Medicare & Medicaid Services (CMS) have released them.
We last updated the costs on this page on November 3, 2020.