Medicare Part A is sometimes called “hospital insurance,” but it only covers the costs of an emergency room (ER) visit if you’re admitted to the hospital to treat the illness or injury that brought you to the ER.
If your ER visit isn’t covered under Medicare Part A, you may be able to get coverage through Medicare Part B, C, D, or Medigap, depending on your specific plan.
Read on to learn more about Part A coverage for ER visits, including what may or may not be covered, and other coverage options you may have.
If you’re treated and released from the emergency department without being admitted to the hospital as an inpatient, chances are Medicare Part A won’t cover your ER visit.
Even if you stay in the ER overnight, Medicare Part A considers you an outpatient unless a doctor writes an order admitting you to the hospital for treatment.
Most of the time, you have to be admitted as an inpatient for two consecutive midnights for Medicare Part A to cover your visit.
What is a MOON form?
If you stay in the hospital overnight as an outpatient, you may receive a form called a Medicare Outpatient Observation Notice (MOON). If you’re in the hospital for observation for more than 24 hours, you must be given this form.
Your MOON form will explain why you’re staying in the hospital as an outpatient and what care you may need when you go home. Getting a MOON is one way to tell which part of Medicare may pay part of your ER bill.
If a doctor admits you to the hospital following an ER visit and you stay in the hospital for two midnights or longer, Medicare Part A pays for your inpatient hospital stay plus the outpatient costs from your ER visit.
You’ll still be responsible for your deductible, coinsurance, and copayments. If you’re not sure whether you’re being treated as an outpatient or inpatient, ask the doctor treating you. If you have a Medigap plan, it may pay part of your copay or coinsurance.
What’s the difference between copays and coinsurance?
- Copayments are fixed amounts you pay for a medical service or office visit. When you visit the ER, you may have several copays based on the number of services you receive. Depending on how the hospital bills, you may not owe copays until sometime after your visit.
- Coinsurance is the percentage of the bill for which you’re responsible. Typically, Medicare requires you to pay 20 percent of the costs for your care.
Medicare Part B
The good news is that Medicare Part B (medical insurance) generally pays for your ER visits whether you’ve been hurt, you develop a sudden illness, or an illness takes a turn for the worse.
Medicare Part B generally pays 80 percent of your costs. You’re responsible for the remaining 20 percent. In 2022, the annual Part B deductible is $233.
Medicare Part C
Medicare Part C (Medicare Advantage) plans also pay for ER and urgent care expenses. Even though Medicare parts B and C usually pay for ER visits, you’ll still be responsible for your deductible, coinsurance, and copayments in addition to your monthly premiums for these plans.
If you have Medigap (Medicare supplement insurance) in addition to your Part B plan, it can help you pay your 20 percent of the cost of the ER visit.
Medicare Part D
Medicare Part D is prescription drug coverage. If you’re given any IV medications while in the ER, Medicare part B or C will usually cover them.
However, if you need medication that you usually take at home and it’s given by the hospital while in the ER, that’s considered a self-administered drug. If the medication you’re given is on your Medicare Part D drug list, Part D may pay for that medication.
You may receive several different kinds of services you may need during an ER visit, including:
- emergency examination by one or more physicians
- lab tests
- scans or screenings
- medical or surgical procedures
- medical supplies and equipment, like crutches
These services and supplies may be billed together or separately, depending on the hospital you visit.
The Agency for Healthcare Research and Quality says the average cost of an ER visit for people 65 and older was $690 in 2017. The amount you have to pay will vary depending on where you live, the condition you’re being treated for, and the coverage your plan provides.
Medicare Part B will pay for an ambulance ride to the ER if your health would be endangered by traveling another way.
For example, if you’re injured and care in an ambulance could save your life, Medicare would pay for you to be transported by ambulance to the nearest appropriate medical center.
If you choose to be treated at a facility farther away, you could be responsible for the difference in cost for transportation between the two facilities.
When should I go to the ER?
If you or a loved one are experiencing any of these signs and symptoms, you should seek care at the ER immediately:
- signs of a stroke, such as slurred speech, weakness on one side, or drooping of the face
- signs of a heart attack, such as chest pain, shortness of breath, dizziness, sweating, or vomiting
- symptoms of dehydration, including fast heart rate, dizziness, muscle cramps, and intense thirst
When you go to the ER, make sure you take any insurance information, along with a list of any current medications.
If you or a loved one needs to go to the ER, it’s important to know that Medicare Part A does not generally cover ER visits unless the patient is admitted to the hospital for treatment.
Medicare Part B and Medicare Advantage plans (Medicare Part C) usually do cover 80 percent of the cost of ER services, but patients are responsible for coinsurance, copayments, and deductibles.
Medicare plan options and costs are subject to change each year.