Medicare Coverage of Emergency Room Treatment


What It Is

Hospital or clinic emergency room treatment

What's Covered

Medicare Part B covers medically necessary treatment in a hospital or clinic emergency room.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for emergency room treatment, contact the plan directly.

What Medicare Pays

Charges for an emergency room visit are usually broken out into two or more parts. There's a charge by the emergency room itself, for which Medicare Part B pays the full Medicare-approved amount, except for a patient co-payment. (This co-payment is waived if the patient is admitted to the hospital, for the same condition, within three days of the emergency room visit.)

There may also be separate charges for each specific medical service (such as X-rays or an EKG) received in the emergency room. For these services, Medicare Part B pays 80 percent of the Medicare-approved amount.

Also, a doctor who cares for a patient in the emergency room usually bills the patient separately. Medicare Part B pays 80 percent of the Medicare-approved amount for the doctor services.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

7 Comments So Far. Add Your Wisdom.

Anonymous said 4 months ago

There may also be separate charges for each specific medical service (such as X-rays or an EKG) received in the<a href="http://www.bluesandtwos.co">medical emergency cards</a> emergency room. For these services, Medicare Part B pays 80 percent of the Medicare-approved amount.


about 1 year ago

Thanks everyone for your comments. For those asking about Medicare coverage for your specific conditions and situation, Medicare.gov or a government health insurance counselor can assist you: http://www.caring.com/local/government-health-insurance-counselors In response to anonymous: Please do make an appointment with your doctor(s) to get help offline as soon as possible. If you're experiencing emotional crisis, you may also call a toll-free help line such as 1-800-784-2433 or 1-800-273-8255. NAMI.org is another resource you can utilize to find offline support in your area. Unfortunately, we cannot assist with mental health crisis on this website -- please do seek help from licensed medical professionals offline for mental health diagnosis and treatment. Thank you!


Anonymous said about 1 year ago

i cant get in to see my psychiatrist, my mental health stus is getting worse. do i go to e.r. or urgent care? will medicare part b pay for mental health services.


over 1 year ago

did not present medicare card at time of service.Did you make claim afterwards ?


Anonymous said over 1 year ago

Neglected to present medicare card to emergency medical provider. Will parts A or B cover ? Will parts A or B cover emergency ambulance transport to hospital ?


over 2 years ago

It is so comforting to be able to sit at home and ask questions instead of going to a doctor's office and sitting for a long time. Thank you.


Anonymous said almost 5 years ago

Fell and hit my head requiring 6 stiches and three staples. Went to Alexian Brothers emergency clinic.My understanding is that mecicare should pay 100% of all charges including initial visit all all emergency doctor charges


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