Does Medicare Cover Emergency Room Visits?

Emergency room visits are fairly common. And everyone knows they are used to treat, well, emergencies. But in some cases, people also go to emergency rooms in non-emergency situations. For example, when your doctor’s office is not available. Or some people will go to the ER to seek treatment for an unusual medical condition or symptoms.

The cost of an emergency room visit can vary widely. So before you go, a common question many people have is, “Does Medicare cover Emergency Room Visits?” In this article, we answer that question in clear, plain English. You will also find the average costs of emergency room visits, as well as other helpful info.

Does Medicare Cover Emergency Room Visits?

The short answer is yes; Medicare will cover the cost of emergency room visits. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your emergency room visits. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for emergency room visits costs.

Medicare Part A

In some cases, Medicare Part A covers the emergency room visit. Medicare Part A will cover ER visits if you are admitted to the hospital to treat the illness or condition that originally brought you to the emergency room.

Most of the time, you have to be admitted as an inpatient for two consecutive nights for Medicare Part A to cover emergency room visits. But if your healthcare provider writes an order admitting you to the hospital for treatment, Medicare Part A may cover the costs.

Medicare Part B

More often than not, however, Medicare Part B will cover emergency room visits. Medicare Part B covers 80% of the cost. You will be responsible for the remaining 20%.

Medicare Part C

Medicare Advantage plans (Medicare Part C) also provide coverage for emergency room visits. They cover everything Original Medicare covers as well as some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part D

There are situations where Medicare Part D may come into play here as well. Suppose you are given a medication that you usually take at home in an emergency room. In that case, Medicare Part D may cover the cost of that medication.

That’s if the prescription given to you is on the Medicare Part D drug lists. In that case, Medicare Part D may cover that medication. However, Medicare Part D does not provide coverage for any IV medications. That is because Medicare Part B or C covers IV medications given in an emergency room.

How Much Does An Emergency Room Visit Costs?

Emergency room visits usually range between $150 and $3,000. Sometimes they can be much more than that. For treatment in life threatening situations, ER costs can even reach up to $20,000 or more.

The cost of an emergency visit will depend on the condition that needs to be treated, the manner of treatment, and many other things like diagnostic tests. Additional fees such as ambulance fees may also add up to the total costs.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.