How Does Medicare Cover an ER Visit?
Because life is unpredictable, you can’t predict whether you’ll end up in a hospital emergency room for care one day. Hopefully, that’ll never happen, but in the United States there are over 130 million emergency room visits per year. If you do need emergency care someday, it’s important to know how your Medicare insurance can help cover that visit.
How does Medicare cover an emergency room visit?
If you’re enrolled in Original Medicare Part A (hospital insurance) and Part B (medical insurance), your coverage for an emergency room visit depends on whether you are admitted to the hospital for further care as a result of that visit.
Medicare Part B typically covers medical services you receive in an emergency department if you’ve been injured, have a sudden illness, or an existing illness suddenly becomes much worse.
When you receive care in a hospital’s emergency department you pay one copayment for the visit and a copayment for each separate hospital service you get there. Medicare Part B pays 80 percent of the final Medicare-approved cost for physician’s services. You are responsible for paying the remaining 20 percent after meeting your annual Part B deductible.
You don’t have to pay these copayments if your physician admits you to the same hospital for a condition related to what you were treated for in the emergency department if you are admitted within three days of the initial ER visit. Medicare Part A covers your emergency department visit if your attending physician formally admits you to the hospital for treatment related to the cause of your ER care and this inpatient hospital stay lasts for at least two consecutive 24-hour periods.
As an inpatient, Medicare Part A pays for the hospital care as well as the costs for the outpatient care you received while you were in the emergency department. You are responsible for paying the Part A deductible for the current benefit period, coinsurance costs, and hospital copayments.
How does a Medicare Advantage (MA) plan cover an ER visit?
Medicare Advantage (Part C) plans must cover, at minimum, all the benefits that Original Medicare Parts A and B do. However, depending on the type of MA plan you have, the amount you pay for your visit and care to a hospital emergency department can vary. Your Medicare Advantage plan could charge a copayment for the visit and physician, or charge a fee for the visit and coinsurance for each medical service you get during the ER visit. Your plan may waive those charges if you’re admitted to the hospital within 24 hours, so make sure to ask your provider for details if you aren’t sure.
How much does an emergency room visit cost without insurance?
It’s difficult to determine the cost of an emergency room visit because it varies according to the care you receive, the severity of your condition, and what hospital you visit. An ER visit usually costs around 12 times more than a visit to a doctor’s office. According to national statistics, the average charge for an uninsured ER visit is $1100 to $1250 but can cost up to $2500.