Does Medicare Cover ER Visits?

We sincerely hope you never end up in the ER.

But emergencies do happen. And, as we get older, we are more prone to medical conditions and accidents that could land us in the ER.

Having to go to the Emergency Room is a frightening experience. And, unfortunately, getting the bill for a visit to the ER can be a frightening experience as well.

Because emergency room visits are so expensive, many over 65 have a common question, “Does Medicare cover ER visits?” In this article, we answer that question in clear, plain English. You will also find the average costs of emergency room visits and other helpful info.

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

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

If you end up in the hospital after first going to the ER, Medicare Part A will generally cover the costs of your emergency room visit. Usually, you will have to be admitted as an inpatient for two or more days for Medicare Part A to cover your emergency room visit costs.

However, Medicare Part A may also cover emergency room visit costs if your healthcare provider writes an order admitting you to the hospital for treatment.

If you don’t end up in the hospital as an inpatient, Medicare Part B covers the costs for ER visits. Part B covers 80% of the cost and you will be responsible for the remaining 20%.

Medicare Advantage

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

Medicare Part D

Let’s look at a situation where, while you’re in the ER, you get a medication that you usually take at home. In that case, Medicare Part D may cover the costs of that medication.

Medicare Part D will also provide coverage for the prescription drugs that you get during your visit to the emergency room. But only if that medication is on the Medicare Part D drug list.

When it comes to IV medications given to you during your emergency room visit, Medicare Part D does not provide coverage for them. That is because coverage for IV medications falls under your Medicare Part B or Part C plan.

How Much Does An ER Visit Cost?

The costs of emergency room visits usually range between $150 to $3,000.

In the case of severe or critical situations, the costs can go much higher. They can reach $20,000 or more.

Other factors that may affect the costs of emergency visits include diagnostic tests fees, ambulance fees, doctor’s fees, and the type(s) of treatments you get.

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.