Does Medicare Cover Emergency Room Visits?
- Medicare Part B covers emergency room visits that don't result in inpatient admission. Medicare Part A covers inpatient hospital care if you're admitted after your emergency department visit.
Medicare covers emergency room visits when you get qualified care, such as medically necessary treatment for a sudden illness or injury.
If your emergency room visit results in a doctor admitting you to the hospital as an inpatient within 3 days of your ER visit, Medicare Part A will cover your emergency room visit as well as your inpatient hospital costs.
Medicare Part B covers emergency room visits and the services you recieve if you're not admitted as an inpatient as a result of your visit.
Does Medicare Part A Cover Emergency Room Visits?
Medicare Part A will sometimes pay for a trip to the emergency room, though only if you are admitted to the hospital as a result of your visit. Medicare Part A will cover your visit to the emergency room if your doctor admits you to the same hospital for inpatient care within 3 days of your ER visit.
Part A pays most of the cost of things like your room, meals, and nurse care and also pays for many treatment services you might receive while staying in the hospital as an inpatient.
You must meet your Part A deductible in a new benefit period before your Part A coverage kicks in.
After you meet your deductible, you may have to pay Part A coinsurance costs if your inpatient hospital stay lasts longer than 60 days.
When Does Medicare Part B Pay for Emergency Room Visits?
Your ride to the hospital in an ambulance is usually considered outpatient care for billing purposes, as is a brief visit to the emergency department. Some of the medical services you might receive if you're admitted as an inpatient may also be covered by Part B.
Even a short stay in the main hospital might be billed as an outpatient expense and therefore covered by Part B if it lasts less than 24 to 48 hours.
Medicare beneficiaries are required to meet the annual Part B deductible before Part B benefits kick in. Once you meet your deductible, you're typically required to pay a 20% Part B coinsurance cost for covered care.
Does Medicare Part D Cover Emergency Department Services?
Drugs administered in the ER are not typically covered by Part D prescription drug plans, nor are medications given to inpatients, such as surgical anesthesia, which would usually fall under Part A.
Medicare Part B also covers some prescription drugs when administered in a hospital emergency room setting or other healthcare settings where the drugs are administered by doctors or other professionals.
Other Resources That Can Help Pay for Emergency Care
Depending on your situation, you may have other factors that impact the cost of emergency room services.
Injuries on the Job
If your trip to the emergency department is a result of a work injury, your employer may pay for the cost of your trip.
Workers’ compensation rules typically require employers to send you for immediate medical evaluation if you have been injured while on the job, and your treatment in the emergency department might covered by the employer’s insurance.
Be sure to check with a human resources representative or other benefits administrator at your employer to learn about your options.
Hospital Programs for People With Limited Means
Hospitals can have special pricing and programs for people with limited means to pay. This is especially likely at county, university and teaching hospitals.
Ask a nurse or other hospital representative at your earliest opportunity about any potential programs and find out if you qualify.
