Does Medicare Cover Emergency Room Visits?

Key Takeaways

• Medicare Part B covers ER visits, but you still pay a deductible and 20% of costs.
• Part A helps only if you're admitted to the hospital.
• Medigap can help cover ER costs if you have Original Medicare.
• Medicare Advantage plans (which replace Original Medicare) cover ER care and may offer lower copays or extra services.
• Want lower, more predictable costs? Medicare Advantage might be a good fit.

When a medical emergency happens, getting the right care quickly is what matters most. Whether it’s a sudden illness or a rapidly worsening condition, emergency room (ER) visits can be life-saving and costly.

Medicare can help cover ER costs. Depending on your plan, different parts of Medicare may apply.

Medicare usually covers ER visits for things like injuries, sudden illness or conditions that get worse quickly. Even if you’re in the hospital for hours or get tests and treatment, most ER visits are considered outpatient care.

8 a.m.-8 p.m., 7 days a week.

Original Medicare (Parts A & B)

What Part B Covers

Medicare Part B usually covers ER services as outpatient care, even though they take place in a hospital. It helps pay for emergency care related to:

• Injuries
• Sudden illnesses
• Conditions that get worse quickly

This includes exams, lab work, imaging and treatment needed to stabilize you.

Your Costs in Original Medicare

If you go to the ER with Original Medicare, you may need to pay:

• A copayment for each ER visit
• A copayment for hospital services
• 20% of the Medicare-approved amount for doctor services
• The annual Part B deductible ($257 in 2025)

These costs can add up, especially if multiple services are involved.

What Part A Covers

Medicare Part A is for inpatient care and does not cover stand-alone ER visits. But it may apply if:

• A doctor admits you to the hospital
• You’re admitted within three days of your ER visit for a related issue

In this case, your ER visit is part of your hospital stay. That means the ER costs are bundled with your inpatient care, and you won’t pay a separate ER copayment.

Medicare Part C (Medicare Advantage Plans)

Medicare Advantage (Part C) is a different way to get Medicare. These plans are offered by private insurance companies. When you join a Medicare Advantage plan, it replaces Original Medicare (Parts A and B). You cannot have both at the same time.

All Medicare Advantage plans must cover emergency room visits the same way Original Medicare does. Many plans also offer extra benefits that vary by plan, such as:

• Telehealth visits
• Rides to follow-up appointments
• Help after you leave the hospital

What to Expect with a Medicare Advantage Plan

• You don’t have to use in-network providers in an emergency
• Out-of-network billing is limited, usually $50 or your in-network cost, whichever is less
• Follow-up care that is medically necessary must be covered
• If coverage is denied, you can file an appeal

Always check your plan documents or call your plan to understand costs and coverage.

Medicare Part D (Prescription Drug Plans)

Medicare Part D helps pay for prescription drugs you take home after an ER visit, like antibiotics or pain medicine. The drugs must:

• Be on your plan’s approved list (formulary)
• Be filled at a pharmacy for home use

It does not cover medicine you receive in the ER. Those are billed through Part B.

Part D coverage is separate from Parts A and B, and you have two main ways to get it:

1. Standalone Part D Prescription Drug Plan (PDP): For those with Original Medicare, you must enroll in a private insurer’s Part D plan. These plans have their own monthly premiums and formularies (drug lists).
2. Medicare Advantage Plan with Drug Coverage (MA-PD): Many Medicare Advantage (Part C) plans bundle Parts A, B, and usually D in one plan, so prescription coverage is included automatically.

Why it matters: Having Part D ensures you have coverage for necessary medications after an ER visit, helping you manage costs and continue your coverage without financial surprises.

Medicare Supplement Plans (Medigap)

For those with Original Medicare, Medigap can help fill in the gaps in ER-related costs.

Overview of Medigap

These optional plans, offered by private insurers, help cover:

• Part A and B deductibles
• Coinsurance and copayments
• Other out-of-pocket expenses

Coverage for ER Visits

Some Medigap plans will pay for some or all of your share of emergency visit costs, such as:

• The 20% Part B coinsurance
• The ER visit copayment

Exact benefits vary by plan, so it’s important to review yours carefully.

Key Things to Know

• Medigap plans help reduce out-of-pocket ER costs
• They are only available with Original Medicare, not Medicare Advantage
• Benefits vary, so always check with your provider

How Much Does an ER Visit Cost?

Emergency room visits can be expensive, especially if you’re not sure what Medicare will cover. Knowing your plan’s details can help you avoid surprise bills.

Original Medicare Costs

If you have Original Medicare, you’ll pay some out-of-pocket costs unless you also have a Medigap plan to help with those expenses.

Typical costs under Original Medicare may include:

• A copayment for the ER visit
• A copayment for hospital services
• 20% of the Medicare-approved amount for doctor services
• The Part B deductible ($257 in 2025)

These costs can add up, especially if your visit involves lab tests, scans or more than one provider.

Medicare Advantage Costs

If you’re enrolled in a Medicare Advantage plan, your ER costs follow that plan’s rules, not Original Medicare. These plans often have set copays for ER visits, and your total costs may be lower or more predictable than with Original Medicare.

Note: you cannot have both Medicare Advantage and Medigap. Medicare Advantage replaces Original Medicare.

Other Factors That Affect Costs

• Several things can change how much you owe, including:
• Whether you have extra coverage, like a Medigap plan, or a Medicare Advantage plan
• If your doctor accepts Medicare assignment (agrees to Medicare’s approved payment amount)
• The type of ER you visit (hospital vs. freestanding)
• Where you receive care, as prices can vary by region

Understanding your coverage ahead of time can help you make informed decisions, even during an emergency.

Costs if Admitted to the Hospital

Sometimes, an emergency room visit leads to a hospital stay. When this happens, your Medicare coverage may shift, and your costs can change, too.

If You Have Original Medicare

Medicare treats ER visits as outpatient care but can change if you’re admitted.

Same hospital, within three days:

If you’re admitted to the same hospital within three days of your ER visit for a related condition:

• Your ER visit becomes part of your inpatient stay
• You don’t pay a separate ER copay
• All related costs are bundled under Part A (hospital insurance)

This can help lower your total costs.

Different hospital or not admitted right away:

If you’re admitted to a different hospital, or more than three days later, the ER visit is billed separately.

• You’ll pay Part B costs for the ER visit.
• You’ll also pay Part A costs for your hospital stay.

Knowing how Medicare handles these situations can help you better plan for bills after an emergency.

Medicare Advantage and Emergency Room Visits

Medicare Advantage (Part C) plans are offered by private insurance companies. When you join a Medicare Advantage plan, it replaces your Original Medicare (Parts A and B). You can’t have both at the same time.

These plans must cover emergency care just like Original Medicare. Many also offer extra benefits, which vary by plan.

Emergency Care Rules

If you have a Medicare Advantage plan, your emergency care is covered, even if:

• You go to an out-of-network hospital
• You’re traveling or far from home
• You don’t get a referral first

Plans are not allowed to charge more than the in-network rate for emergency services. They also must cover follow-up care if it’s related to your emergency.

Possible Extra Benefits

Some Medicare Advantage plans may offer:

• Lower copays for ER visits
• Access to telehealth or nurse hotlines
• Help with rides to follow-up appointments
• Care coordination after your ER visit

These benefits are not required, and they can vary based on where you live and which plan you choose.

Know Your Costs

Each plan sets its own costs. This may include:

• A set copay for each ER visit
• Coinsurance for services like imaging or labs
• A plan-specific deductible

Always check your Evidence of Coverage (EOF) or talk to your plan provider to understand your exact costs.

Emergency Services Outside the U.S.

Medicare may cover emergency care outside the U.S. if:

• You’re traveling between Alaska and another state through Canada
• A foreign hospital is closer than a U.S. facility for your condition

These are rare and come with limits. If you travel often, consider a supplemental travel policy.

When It’s Not an Emergency

Even if your visit turns out not to be an emergency, Medicare usually covers it if it is reasonable to think it is urgent.

For example, chest pain that turns out to be heartburn would still be covered.

Choosing the Right Coverage for ER Visits

Emergency room visits are never planned, but your Medicare coverage can help you prepare.

To recap:

• Medicare Part B covers most ER visits, but you’ll still pay a deductible and coinsurance.
• Medicare Part A only helps if you’re admitted to the hospital.
• Medigap can help lower your out-of-pocket costs if you have Original Medicare.
• Medicare Advantage is an alternative to Original Medicare and may offer lower ER copays, extra support services and an annual out-of-pocket max.
• Original Medicare has no cap on yearly costs but may offer more flexibility when choosing providers.
• If you’re concerned about high ER costs or want more predictable healthcare spending, Medicare Advantage is worth considering.

Emergency? You’re covered either way. However, knowing how each option works can help you plan ahead and choose the coverage that fits your needs best.

8 a.m.-8 p.m., 7 days a week.

FAQs

Do I Need a Referral to Go to the ER with Medicare?

No, you do not need a referral. Whether you have Original Medicare or a Medicare Advantage plan, you can go to the emergency room without getting a referral first. In an emergency, your health and safety come first.

Does Medicare Part A Cover ER Visits?

Only in specific situations. Medicare Part A typically doesn’t cover emergency room visits, because it’s designed for inpatient hospital care. However, if you’re admitted to the same hospital within three days of your ER visits for a related condition, Part A may cover the cost as part of your inpatient stay.

Does Medicare Part B Cover ER Visits?

Medicare Part B usually covers emergency room services when they are needed to treat sudden injuries, illnesses or conditions that get worse quickly. You’ll still be responsible for cost-sharing, such as copayments, coinsurance and the Part B deductible.

What does Medicare Advantage cover that Original Medicare doesn’t?

Medicare Advantage plans may include extra perks like lower ER copays, follow-up care or rides to the doctor.

Note: Plans vary. Check your plan to see what’s included.

Does Medicare Cover Emergency Services Outside the U.S.?

Only in very rare circumstances. Medicare does not typically cover medical care outside of the United States. However, it may pay for emergency services in limited situations—such as if you’re in Canada traveling between Alaska and another U.S. state, or if the nearest hospital that can treat you is in a foreign country.

Sources

• CMS.gov: 2025 Medicare Parts A & B Premiums and Deductibles
• Medicare Interactive: Emergency room services
• Medicare.gov: Emergency department services
• Uhc.com: Does Medicare cover emergency room visits?
• Humana.com: Does Medicare cover emergency room visits?
• ehealthinsurance.com: Does Medicare cover emergency room visits?

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Disclaimers