how much does er visit cost with insurance

How Much Does an ER Visit Cost? Free Local Cost Calculator 

It’s true that you can’t plan for a medical emergency, but that doesn’t mean you have to be surprised when it’s time to pay your hospital bill. In 2021, the U.S. government enacted price transparency rules for hospitals in order to demystify health care costs. That means it should be easier to get answers to questions like how much an ER visit costs.

While the question seems pretty straightforward, the answer is more complicated. Your cost will vary based on factors such as if you’re insured, whether you’ve met your deductible, the type of plan you have, and what your plan covers. 

There is a lot to consider. This guide will take you through specific scenarios and answer questions about insurance plans, deductibles, co-payments, and discuss scenarios such as how much it costs if you go to the ER when it isn’t an emergency. 

You’ll learn a few industry secrets too. Did you know that if you don’t have insurance you might see a higher bill? According to the Wall Street Journal , it’s common for hospitals to charge uninsured and self-pay patients higher rates than insured patients for the same services. So, where can you go if you can’t afford to go to the ER?

Keep reading for all this plus real-life examples and cost-saving tips.

How Much Does an ER Visit Cost Without Insurance?

Everything is more expensive in the ER. According to UnitedHealth, a trip to the emergency department can cost 12 times more than a typical doctor’s office visit. The average ER visit is $2,200, and doesn’t include procedures or medications. 

If you want to get a better idea of what an ER visit will cost in your area, check out our medical price comparison tool that analyzes data from thousands of hospitals.

Compare Procedure Costs Near You

Other out-of-pocket expenses you may incur include bills from third parties. A growing number of emergency departments in the United States have become business entities separate from the hospital. So, third-party providers may bill you too, like:

• EMS services, like an ambulance or helicopter 
• ER physicians
• Attending physician
• Consulting physicians
• Advanced practice nurses (CRNA, NP)
• Physician assistants (PA)
• Physical therapists (PT)

And if your insurance company fails to pay, you may have to pay these expenses out-of-pocket.

How Much Does an ER Visit Cost With Insurance? 

The easiest way to estimate out-of-pocket expenses for an ER visit (or any other health care service) is to read your insurance policy. You’ll want to look for information around these terms:

• Deductible: The amount you have to pay out-of-pocket before your insurance kicks in . 
• Copay: A set fee you pay upfront before a covered medical service or procedure. 
• Coinsurance: The percentage you pay for a service or a procedure once you’ve met the deductible.
• Out-of-pocket maximum: The most you will pay for covered services in a rolling year. Once met, your insurance company will pay 100% of covered expenses for the rest of the year. 

Closely related to out-of-pocket expenses like deductibles and co-insurance are premiums. A premium is the monthly fee you (or your sponsor) pay to the insurance company for coverage. If you pay a higher premium, you’ll have a lower deductible and fewer out-of-pocket costs whenever you use your insurance to pay for services such as a visit to the ER. The opposite is also true — high deductible health plans (HDHP) offer lower monthly payments but much higher deductibles. 

Sample ER Visit Cost

Using a few examples from plans available on the Marketplace on Healthcare.gov (current as of November 2021), here’s how this might play out in real life:

Rob is a young, healthy, single guy. He knows he needs health insurance but he feels reasonably sure that the only time he’d ever use it is in case of an emergency. Here’s the plan he chooses:

Plan: Blue Cross/Blue Shield Bronze Monthly premium: $394 Deductible: $7,000 Out-of-pocket maximum: $7,000 ER coverage: 100% after meeting the deductible

Rob does the math and considers the worst case scenario. If he does go to the ER, he’ll pay full price if he hasn’t yet met his deductible. But since both his deductible and his maximum out-of-pocket are the same, $7,000 is the most he’ll have to pay before his insurance kicks in at 100%.

Now imagine that Rob gets married and is about to start a family. He might need a different insurance plan to account for more hospital bills, doctors appointments, and inevitable emergency room visits.

Since Rob knows he’ll be using his insurance more often, he picks a plan with a lower deductible that covers more things. 

Plan: Bright HealthCare Gold Monthly premium: $643 Deductible: $0 Out-of-pocket maximum: $6,500 ER coverage: $500 Vision: $0 Generic prescription: $0 Primary care: $0 Specialist: $40

This time Rob goes with a zero deductible plan with a higher monthly premium. It’s more out-of-pocket each month, but since his plan covers doctor’s visits, prescription drugs, and vision, he feels more prepared as his lifestyle shifts into family mode. 

If he has to go to the ER for any reason, all he’ll pay is $500 and his insurance pays the rest. And worse case scenario, the most he’ll pay out-of-pocket in a year is $6,500. 

How Much Does an ER Visit Cost if You Have Medicare?

Medicare Part A only covers an emergency room visit if you’re admitted to the hospital. Medicare Part B covers 100% of most ER costs for most injuries, or if you become suddenly ill. Unlike private insurance and insurance purchased on the Affordable Care Act (ACA) Marketplace, Medicare rarely covers ER visits that happen while you’re outside of the United States.

To learn more, read: How to Use the Healthcare Marketplace to Buy Insurance

How Much Does an ER Visit Cost for Non-Emergencies?

When you have a sick child but lack insurance, haven’t met your deductible, or if you’re between paychecks, just knowing you can go to the ER without being hassled for money feels like such a relief. ER staff won’t demand payment upfront, and they usually don’t ask about insurance or assess your ability to pay until after discharge.

There are other reasons, too. You might be tempted to go to the ER for situations that are less than emergent because emergency departments provide easy access to health services 24/7, including holidays and the odd hours when your primary care physician isn’t available. If you’re one of the 61 million Americans who are uninsured or underinsured , you might go to the ER because you don’t know where else to go.

What you may not understand is the cost of an ER visit without insurance can total thousands of dollars. Consumers with ER bills that get sent to collections face some of the most aggressive debt collection practices of any industry. Collection accounts and charge-offs could affect your credit score for the better part of a decade.

Did you know that charges begin racking up as soon as you give the clerk your name and Social Security number? There are tons of horror stories out there about people receiving medical bills after waiting, some for many hours, and leaving without treatment. 

4 ER Alternatives Ranked by Level of Care

First and foremost, if you’re experiencing a medical emergency, call 911 or go to the closest emergency room. Do not rely on this or any other website for advice or communication. 

If you’re not sure whether your condition warrants immediate, high-level emergency care, you can always call your local ER and ask to speak to their triage nurse. They can quickly assess how urgent the situation is. 

If you are looking for a lower-cost alternative to the ER, this list provides a few options. Each option is ranked by their ability to provide you with a certain level of care from emergent care to the lowest level, which is similar to the routine care you would receive at a doctor’s office. 

1. Charitable Hospitals  

There are around 1,400 charity hospitals , clinics, and pharmacies dedicated to serving low-income families, including the uninsured. Most charitable, not-for-profit medical centers provide emergency room services, making it a good option if you’re uninsured and worried about accruing substantial medical debt. 

ERs at charitable hospitals provide the same type of medical care for conditions like trauma, broken bones, and life-threatening issues like chest pain and difficulty breathing. The major difference is the price tag. Emergency room fees at a charity hospital are usually flexible and almost always based on your income. 

2. Urgent Care Centers

Urgent care centers are free-standing facilities designed to treat patients with serious but not life-threatening conditions. Also called “doc in a box,” these ambulatory care centers are a good choice for treating stable but chronic health issues, fever, urinary tract infections, back pain, abdominal pain, and moderately high blood pressure, to name a few. 

Urgent care clinics usually have a medical doctor on-site. Some clinics offer point-of-care diagnostic tests like ultrasound and X-rays, as well as basic lab work. The average cost for an urgent care visit is around $180, according to UnitedHealth.

3. Retail Health Clinics

You may have noticed small retail health clinics (RHC) popping up in national drugstore chains like CVS, Walgreens, and in big-box stores like Target and Walmart. The Little Clinic is an example of an RHC that offers walk-in health care services at 190 supermarkets across the United States. 

RHCs help low-acuity patients with minor medical problems like sore throat, cough, flu-like symptoms, and other conditions normally treated in a doctor’s office. If you think you’ll need lab tests or other procedures, an RHC may not be the best choice. Data from UnitedHealth puts the average cost for an RHC visit at $100.

4. Telehealth Visits

Telehealth, in some form, has been around for decades. Until recently, it was mostly used to provide access to care for patients living in the most remote or rural areas. Since 2020, telehealth visits over the phone, via chat, or through videoconferencing have become a legitimate and extremely cost-effective alternative to in-person office visits. 

Telehealth is perfect for some types of mental health therapies, follow-up appointments, and triage. For self-pay, a telehealth visit only costs around $50, according to UnitedHealth.

Tips for Taking Control of Your Health Care

• Don’t procrastinate. Delaying the care you need for too long will end up costing you more in the end. 
• Switch your focus from reactive care to proactive care. Figuring out how to pay for an ER visit is a lot harder (and costlier) than preventing an ER visit in the first place. Data show that preventive health care measures lead to fewer illnesses and better outcomes.
• Plan for the unknown. It’s inevitable that at some point in your life you’ll need health care. Start a savings account fund or better yet, enroll in a health savings account (HSA). If you’re employed (even part-time) you already qualify for an HSA. A contribution of just $9 a paycheck could add up to $468 tax-free dollars for you to spend on health care every year. Unlike the use-it-or-lose-it savings plans of the past, modern plans don’t expire. You can use HSA dollars to pay for out-of-pocket costs like copayments, deductibles, and for services that your health insurance may not cover, like dental and vision services. 
• Advocate for yourself. There is nothing more empowering than taking charge of your health. Shop around for services and compare prices on procedures to make sure you’re getting the best prices possible.
• If you are uninsured or doing self-pay, negotiate your bill and ask for a cash discount. 

Estimate the Cost of the ER Before You Need It

It’s stressful to think about money when you’re facing an emergency. Research the costs of your nearest ER before you actually need to go with Compare.com’s procedure cost comparison tool . 

All you have to do is enter your ZIP code and you’ll immediately see out-of-pocket costs for ER visits at your local emergency rooms. It works for other medical services too, like MRIs, routine screenings, outpatient procedures, and more. Find the treatment you need at a price you can afford.

Disclaimer: Compare.com does not offer medical advice and is in no way a substitute for any medical advice received from health professionals. Compare.com is unable to offer any advice on any medical procedure you may need.

Nick Versaw leads Compare.com's editorial department, where he and his team specialize in crafting helpful, easy-to-understand content about car insurance and other related topics. With nearly a decade of experience writing and editing insurance and personal finance articles, his work has helped readers discover substantial savings on necessary expenses, including insurance, transportation, health care, and more.

As an award-winning writer, Nick has seen his work published in countless renowned publications, such as the Washington Post, Los Angeles Times, and U.S. News & World Report. He graduated with Latin honors from Virginia Commonwealth University, where he earned his Bachelor's Degree in Digital Journalism.

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• An emergency room visit typically is covered by health insurance. For patients covered by health insurance, out-of-pocket cost for an emergency room visit typically consists of a copay, usually $50-$150 or more, which often is waived if the patient is admitted to the hospital. Depending on the plan, costs might include coinsurance of 10% to 50%.
• For patients without health insurance, an emergency room visit typically costs from $150-$3,000 or more, depending on the severity of the condition and what diagnostic tests and treatment are performed. In some cases, especially where critical care is required and/or a procedure or surgery is performed, the cost could reach $20,000 or more. For example, at Park Nicollet Methodist Hospital in Minnesota, a low-level emergency room visit, such as for a minor laceration, a skin rash or a minor viral infection, costs about $150 ; a moderate-level visit, such as for a urinary tract infection with fever or a head injury without neurological symptoms, about $400 ; and a high-level visit, such as for chest pains that require multiple diagnostic tests or treatments, or severe burns or ingestion of a toxic substance, about $1,000, not including the doctor fees. At Dartmouth-Hitchcock Medical Center[ 1 ] , a low-level emergency room visit costs about $220, including hospital charge and doctor fee, with the uninsured discount, while a moderate-level visit costs about $610 and a high-level visit about $1,400 .
• Services, diagnostic tests and laboratory fees add to the final bill. For example, Wooster Community Hospital, in Ohio, charges about $170 for a simple suture, $200 for a complex suture, about $170 for a minor procedure and about $400 for a major procedure, not including doctor fees, medicine or supplies.
• A doctor fee could add hundreds or thousands of dollars to the final cost. For example, at Grand Lake Health System[ 2 ] in Ohio, an emergency room doctor charges about $100 for basic care, such as a wound recheck or simple laceration repair; about $300 for mid-level care, such as treatment of a simple fracture; about $870 for advanced-level care, such as frequent monitoring of vital signs and ordering multiple diagnostic tests, administering sedation or a blood transfusion for a seriously injured or ill patient; and about $1,450 for critical care, such as major trauma care or major burn care that could include chest tube insertion and management of IV medications and ventilator for a patient with a complex, life-threatening condition. At the Kettering Health Network, in Ohio, a low-level visit costs about $350, a high-level visit costs about $2,000 and critical care costs almost $1,700 for the first hour and $460 for each additional half hour; ER procedures or surgeries cost $460-$2,300 .
• According to the U.S. Agency for Healthcare Research and Quality[ 3 ] the average emergency room expense in 2008 was $1,265 .
• According to the U.S. Centers for Disease Control and Prevention, in 2008, about 18%of emergency room patients waited less than 15 minutes to see a doctor, about 37%waited 15 minutes to an hour, about 15% waited one to two hours, about 5% waited two to three hours, about 2% waited three to four hours, and about 1.5% waited four to six hours.
• In some cases, the doctor might recommend the patient be admitted to the hospital. The American College of Emergency Physicians Foundation offers a guide[ 4 ] on what to expect.
• An ambulance ride typically costs $400-$1,200 or more, depending on the location and services performed.
• An urgent care center offers substantial savings for more minor ailments. DukeHealth.org offers a guide[ 5 ] on when to seek urgent care. An urgent care visit typically costs between 20% and 50% of the cost of an emergency room visit. MainStreetMedica.com offers a cost-comparison tool for common ailments.
• Hospitals often offer discounts of up to 50% or more for self-pay/uninsured emergency room patients. For example, Ventura County Medical Center[ 6 ] in California offers ER visits, including the doctor fee and emergency room fee but not including lab tests, X-rays or procedures, for $150 for patients up to 200% of the federal poverty level, for $225 for patients between 200% and 500% of the federal poverty level and $350 for patients from 500% to 700% of the federal poverty level.
• The American College of Emergency Physicians Foundation offers a primer[ 7 ] on when to go to the emergency room.
• In most cases, it is recommended to go to the nearest emergency room. The U.S. Department of Health and Human Services offers a hospital-comparison tool[ 8 ] that lists hospitals near a chosen zip code.
•   patients.dartmouth-hitchcock.org/billing_questions/out_of_pocket_estimator_dhmc.ht...
•   www.grandlakehealth.org/index.php?option=com_content&view=article&id=106&Itemid=60
•   meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPS...
•   www.EmergencyCareforYou.org/VitalCareMagazine/ER101/Default.aspx?id=1288
•   www.dukehealth.org/health_library/health_articles/wheretogo
•   resources.vchca.org/documents/SELF%20PAY%20DISCOUNT%20GRID%20-%20BOARD%20LETTER%20...
•   www.EmergencyCareforYou.org/YourHealth/AboutEmergencies/Default.aspx?id=26018
•   www.medicare.gov/hospitalcompare/(S(efntd2saaeir2l5pgarwuvvg))/search.aspx?AspxAut...

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Emergency Room Visit: When to Go, What to Expect, Wait Times, and Cost

Knowing when and why to go for an emergency room visit can help you plan for care in the event of a medical emergency.

How much does it cost to go to an emergency room?

Emergency Room (ER) costs can vary greatly depending on what type of medical care you need. How much you pay for the visit depends on your health insurance plan. Most health plans may require you to pay something out-of-pocket for an emergency room visit. A visit to the ER may cost more if you have a High-Deductible Health Plan (HDHP) and you have not met your plan’s annual deductible. HDHP's typically offer lower monthly premiums and higher deductibles than traditional health plans. Your plan will start paying for eligible medical expenses once you’ve met the plan’s annual deductible. Here are some tips to pay less out of pocket .

When should I go to an emergency room?

Emergency rooms are often very busy because many people don’t know what type of care they need, so they immediately go to the ER when they are sick or hurt. You should make an emergency room visit for any condition that’s considered life-threatening.

Life-threatening conditions include, but are not limited to, things like a serious allergic reaction, trouble breathing or speaking, disorientation, a loss of consciousness, or any physical trauma.

If you need to be treated for problems that are considered non-life threatening, such as an earache, fever and flu symptoms, minor animal bites, mild asthma, or a mild urinary tract infection, consider seeing your doctor or visiting an urgent care center or convenience care clinic.

What is the cost of an emergency room visit without insurance?

Emergency room costs with or without health insurance can be very high. If you have health insurance, review your plan documents for details on the costs associated with your plan, including your plan deductible, coinsurance, and copay requirements.

If you don’t have insurance, you may be required to pay the full cost of your treatment, which can vary by facility and the type of treatment required. Always plan ahead for sudden sickness, injury, or other medical needs, so you know where to go and how much it could cost. If you need medical care, but it’s not life-threatening you may not have to go to the ER—there are other more affordable options:

• Urgent care center: Staffed by doctors, nurses, and other medical staff who can treat things like earaches, urinary tract infections, minor cuts, nausea, vomiting, etc. Wait times may be shorter and using an urgent care center could save you hundreds of dollars when compared to an ER.
• Convenience care clinic: Walk-in clinics are typically located in a pharmacy (CVS, Walgreens, etc.) or supermarket/retail store (Target, Walmart, etc.). These clinics are staffed with physician assistants and nurse practitioners who can provide care for minor cold, fever, flu, rashes and bruises, head lice, allergies, sinus/ear infections, urinary tract infections, even flu and shingles shots. No appointments are needed, wait times are usually minimal, and a convenience care clinic costs much less than an ER.

Plan ahead for when you need medical care. You may not need an emergency room visit and the bill that could come with it.

What are common emergency room wait times?

Emergency room wait times vary according to hospital and location. Patients in the ER are seen based on how serious their condition is. This means that the patients with life-threatening conditions are treated first, and those with non-life threatening conditions have to wait.

To help reduce ER wait times, health care facilities encourage you to plan ahead for care, so when you’re sick or hurt, you know if the ER is right for your medical condition.

An emergency room visit can take up time and money if your problem is not life-threatening. Consider other care options, such as an urgent care center, convenience care clinic, your doctor, or a virtual doctor visit (video chat/telehealth)—all of which could be faster and save you money out of your own pocket if the medical problem is non-life threatening.

If you have health insurance, be sure to check your plan documents to see what types of care options are eligible for coverage under your plan, including whether or not you need to stay in your plan’s network.

Is taking an ambulance to the emergency room free?

An ambulance ride is not free, but your insurance may cover some of the costs for the ride, as well as the emergency room visit. Check your plan benefits to see what out-of-pocket expenses you are responsible for when it comes to an ambulance ride and a visit to the ER.

Plan ahead for times you may need immediate medical care. Review the details of your health plan so you know the costs for an ER visit should you ever need it. Know when it’s best to go to the emergency room and when going somewhere else, like an urgent care center, convenience care clinic, your doctor, or even a virtual doctor visit (video chat/telehealth), is the right option that may save you time and money.

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Health Care

Why an er visit can cost so much — even for those with health insurance.

Terry Gross

Vox reporter Sarah Kliff spent over a year reading thousands of ER bills and investigating the reasons behind the costs, including hidden fees, overpriced supplies and out-of-network doctors.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. You wouldn't believe what some emergency rooms charge, or maybe you would because you've gotten bills. For example, one hospital charged $76 for Bacitracin antibacterial ointment. One woman who fell and cut her ear and was given an ice pack but no other treatment was billed $5,751. My guest, Sarah Kliff, is a health policy journalist at vox.com who spent over a year investigating why ER bills are so high even with health insurance and why the charges vary so widely from one hospital to the next.

Through crowdsourcing, she collected over a thousand ER bills from around the country. She interviewed many of the patients and the people behind the billing. She's reported her findings in a series of articles on Vox. She's also spent years reporting on the battle over health insurance policy. We'll get some updates on the state of Obamacare a little later in the interview.

Sarah Kliff, welcome back to FRESH AIR. Why did you want to do an investigation into emergency room billing?

SARAH KLIFF: You know, I wanted to do this because the emergency room is such a common place where Americans interact with the health care system. There are about 140 million ER visits each year. It's a place where you can't really shop for health care. You can't make a lot of decisions about where you want to go. So I think that is big-picture what got me interested.

Small picture was actually a bill that someone sent me almost three years ago now, where they took their daughter to the emergency room. A Band-Aid was put on the daughter's finger, and they left. And they got a $629 bill. And they said - you know, they - the parents sent this to me, saying, how could a Band-Aid cost $629? And I said, I don't know, but I'm going to find out. And that kind of opened up the door to this, you know, multi-year project I've been working on right now. It started with trying to figure out why a Band-Aid would cost $629.

GROSS: OK. So let's get to that $629 for treatment that was basically a Band-Aid placed on a finger. You investigated that bill.

KLIFF: Yes.

GROSS: Why'd it cost so much?

KLIFF: So what cost so much was really the facility fee. So this is a charge I hadn't heard about before as a health care reporter. This is a charge that hospitals make for just keeping their doors open, keeping the lights on, the cost of running an emergency room 24/7. So if you look at that particular patient's bill, the Band-Aid - you know, I hesitate to say only - but the Band-Aid only cost $7, which, as anyone who's bought Band-Aids knows, is quite expensive for a single Band-Aid.

But the other $622 of that bill were the hospital's facility fees for just walking in the door and seeking service. And these fees are not made public. They vary wildly from one hospital to another. And usually patients only find out what the facility fee of their hospital is when they receive the bill afterwards, like that patient, you know, that sent me this particular bill.

GROSS: And does the facility fee vary from facility to facility?

KLIFF: It does significantly. You know, I've seen some that are in the low hundreds. I've seen some that are in the high thousands. And it's impossible to know what facility fee you're going to be charged until you actually get the billing documents from your hospital. And if you try and call up a hospital and ask what the facility fee is, usually you won't get very far.

So it's this fee that, from all the ER bills I've read, is usually the biggest line item on the bill. But it's also one that is very, very difficult to get good information about until you've already been charged.

GROSS: So you're paying the facility fee to basically share in the cost of running the emergency room.

KLIFF: Yes, that's how hospital executives would describe the fee.

GROSS: But you don't know that when you're going to the emergency room.

KLIFF: You don't, no. And you don't know how much it'll be. You don't know how it's being split up between different patients. You don't know any of that.

GROSS: So is this also why one bill had $60 for the treatment of ibuprofen and another $238 for the treatment of eyedrops?

KLIFF: Yeah. And, you know, this is something I see all the time reading emergency bills - I've read about 1,500 of them at this point - is that things you could buy in a drugstore often cost significantly more in the emergency room. And the people I talked to who run hospitals will say this is because they have to be open all the time. They have to have so many supplies ready.

But I think one of the things that I find pretty frustrating is, you know, patients aren't usually told, we can give you an ibuprofen here, or you can pick some up at the drugstore if you leave, and the cost will be a fraction of what we would charge you here. That information often isn't conveyed to patients who are well enough, you know, to go to a drugstore on their own. But it's just huge variation for these simple items.

One place I see this a lot is pregnancy tests. If you're a woman who's of childbearing age, you go to the emergency room, they will often want to check if you're pregnant. I've seen pregnancy tests that cost a few dollars in emergency room. The most expensive one I saw was over $400. I believe that was at a hospital in Texas. It's just widespread variation for, you know, some pretty simple pieces of medical equipment.

GROSS: I want to get back to the $60 ibuprofen. Is that - does that include the facility fee? Or is that just for the ibuprofen, and the facility fee is separate?

KLIFF: That's just for the ibuprofen. The facility fee is totally separate.

GROSS: So how do they justify that?

KLIFF: They say they have to stock, like, a wide array of medicine, so they have to have everything on hand from ibuprofen, from, you know, expensive rabies treatments - I've talked to a lot of people who've been to the emergency room for exposure to bats and raccoons - and that they need to have all these things in stock. And, you know, one of the things you pay for at the emergency room is the ability to get any medication at any hour of the day right when you need it. I don't necessarily buy that explanation, to be clear. That's what I've heard from hospital executives.

I think it's pretty telling that ibuprofen has a very, very different price depending on which emergency room you go to. The fact that there's so much widespread price variation suggests to me that it's not just the cost of doing business driving it, that there's also business decisions being made behind ibuprofen that are driving the prices different hospitals are setting.

GROSS: Now, of course, trips to the emergency room aren't always as simple as getting a Band-Aid or ibuprofen or some eyedrops. I want you to describe the case of a young man who was hit by a pole on a city bus in San Francisco.

KLIFF: Yeah. So this patient, his name is Justin. He was a community college student in northern California, was walking down a sidewalk in downtown San Francisco one day. And there was a pole hanging off the back of the bus that wasn't where it's supposed to be. It essentially flew off the back of the bus, hit him in the face and knocked him unconscious.

And the next thing he knows, he's waking up at Zuckerberg San Francisco General, which is the only Level I trauma center in the city. He ends up needing a CT scan to check out some brain injuries. He needs some stitches. And then he's discharged. He ends up with a bill for $27,000.

But, you know, as I began figuring out through my reporting, San Francisco General does not contract with private insurance, and they end up pursuing him for the vast majority of that bill. He has $27,000 outstanding. And somewhat ironically, San Francisco General, it is the city hospital. It is run by the city of San Francisco. So this student is hit by a city bus, taken by an ambulance to the city hospital and ends up with a $27,000 bill as a result.

GROSS: So did he have insurance?

KLIFF: He did. He had insurance through his dad.

GROSS: So why doesn't Zuckerberg San Francisco General Hospital contract with private insurers?

KLIFF: So what they have told me when I've talked to some spokespeople there is that they are a safety net hospital, and that is, you know, definitely true. They generally serve a lower-income, often indigent population in San Francisco that would have trouble getting admitted and seeking care at other hospitals in the city. So they have told me that their focus is on serving those patients and that therefore, you know, they're not going to contract with private insurance companies.

The thing I found a little bit confusing about that, though, is there are lots of public hospitals, say, that, you know, also serve low-income populations. And some of them for their inpatient units, you know, for their scheduled surgeries, they're not going to contract with private insurance because they want to make sure beds are available for the publicly insured folks and people on Medicaid and Medicare.

But when it comes to the emergency room, you know, every other public hospital I was in touch with would contract with private insurers there because people don't decide if they're going to end up in the emergency room. So, you know, that's the justification they offered, that it is a hospital meant to serve those with public insurance. But it is not something you see public hospitals typically doing.

GROSS: Isn't - I think legislation was proposed in California to change that. Did that pass?

KLIFF: It's still pending in the California State Assembly. And the hospital has also promised to reform its billing practices, although we haven't seen what exactly their new plan is yet.

GROSS: So the position that Justin was in is that, like, he's unconscious. He's not asking to be taken anyplace. (Laughter) But he's unconscious. He's taken to the emergency room and ends up getting this $27,000 bill. I mean, that just seems so unfair, especially since he has insurance.

KLIFF: Yeah.

GROSS: Like, it's supposed to cover him for things like that (laughter).

KLIFF: Yeah. You know, there's one other patient who kind of makes this point really well who was also seen at San Francisco General. Her name is Nelly. And she fell off a climbing wall and, somewhat amazingly, you know, turns out she had a concussion. But one of the first things she does is she calls her insurance's nursing hotline to ask, should I go to the ER?

And they say yes. And she says, can I go to Zuckerberg San Francisco General? It's the closest. They say, no, don't go there. It's not in network. Go to another hospital. She gets to the other hospital, but the other hospital won't see her because she's a trauma patient. She fell from a really high height. And San Francisco General is the only trauma center in San Francisco. So she tries to go to an in-network hospital. She's then ambulance-transferred to Zuckerberg San Francisco General, and she ends up with another bill over $20,000 that the hospital was pursuing from her until I started asking questions from it, and the hospital ultimately dropped the bill.

But I think it's just such a frustrating situation for someone like Justin, for someone like Nellie (ph). They're either shopping for this good unconscious, they're really trying to do the right thing, and the health care system is just so stacked against the patient. It's so stacked for the hospital to be able to bill the prices that they want to bill.

GROSS: So apparently, the moral of the story is if you want to challenge your emergency room bill, you should get Sarah Kliff to write about you. (Laughter).

KLIFF: It's - (laughter). That's what some people have said. But there's only one of me, and there's about 2,000 bills in our database. And, you know, we have had over $100,000 in bills reversed as a result of our series. But I don't think it's a great way to run a health care system where we just, you know, the people who get their bills reversed are those who are lucky enough to have a reporter write a story about them.

GROSS: Yes. Agreed. Let me reintroduce you. If you're just joining us, my guest is Sarah Kliff. She's a senior policy correspondent at Vox, where she focuses on health policy. She also hosts the Vox podcast, "The Impact," about how policy actually affects people.

So we're going to take a short break, and then we'll talk more about emergency billing. And then later, we'll talk about what's left of Obamacare, and what the president and Congress and candidates are saying about health care, after this break. This is FRESH AIR.

(SOUNDBITE OF ALEXANDRE DESPLAT'S "SPY MEETING")

GROSS: This is FRESH AIR. And if you're just joining us, my guest is Sarah Kliff. We're talking about emergency room billing and why it's so unpredictable and often so incredibly high. She's a senior policy correspondent at Vox, where she focuses on health policy. She also hosts the Vox podcast, "The Impact," about how policy affects people.

So we were talking about the hidden facility fee, which most people don't know exists, and is responsible for a large chunk of a lot of emergency room bills. There's also, like, a trauma unit fee. It's a similar hidden fee in hospitals that have trauma centers in their emergency rooms. So explain the trauma fee and how that kicks in.

KLIFF: Yeah. This is something I also had never heard of till I started reading a lot of emergency room bills, and this is the fee that trauma centers charge for essentially assembling a trauma team to meet you when you're coming in and those folks out in the field, maybe the EMTs, for example, have determined that you meet certain trauma criteria.

So I've talked to people who have been charged trauma fees who were in serious car accidents. One case was a baby who fell from more than 3 feet, and that's considered to trigger a trauma activation. So this is essentially the price for having a robust trauma team - a surgeon, an anesthesiologist, nurses - all at the ready to receive you when you get to the hospital.

And again, these fees can be pretty hefty. San Francisco General, which, I've done the most reporting on their billing, you know, they can charge up to $18,000 for their trauma activation services. I wrote about one family who was visiting San Francisco from Korea when their young son rolled out of the hotel bed. They were nervous. They didn't know the American health care system well. So they called 911, which sent an ambulance, brought him over to the hospital. Turns out, he was fine. They gave him a bottle of formula. He took a nap and went home.

And then a few months later, they get an $18,000 charge for the trauma team that assembled for when that baby came to the hospital. And these are another, you know, pretty significant fee that, again, you don't really know about. You have no idea that the trauma team is assembling to meet you when you're coming into the hospital. You just find out after the fact. And you also have no say in the decision to assemble trauma. That's really left up to the hospital, not the patient.

GROSS: So I'm going to have you compare two possibilities. You go to an emergency room, and the bill is very high. There's two people who have the same problem who go to the emergency room. One of them has a copay. One of them has a high deductible that they haven't paid off yet. How are they treated differently, in terms of what they're billed for the emergency room visit?

KLIFF: Well, the person with the deductible will likely be billed significantly more. You know, if they're just, let's say, at the start of the year, they are going to essentially have to bear the costs of that emergency room visit up until the point they hit their deductible and the insurance kicks in, whereas the person who has a co-payment, they're just going to have to pay that flat fee and, you know, probably not worry about paying more, but there's often surprise bills lurking in the corner that could affect both of those patients as well.

GROSS: Like what?

KLIFF: So one of the most common things we see is out-of-network doctors working at in-network emergency rooms. So you know, you have an emergency, you look up a hospital, you see their ER is in network, so you go there. It turns out that emergency room is staffed by doctors who aren't in your insurance. There's pretty compelling academic research that suggests 1 in 5 emergency room visits involves a surprise bill like that one.

GROSS: That seems so unfair. How are you to know - if you're choosing a hospital that's in network, how are you to know whether the doctor treating you is in network or not?

KLIFF: You know, you really - there isn't a great way to tell, to be honest. This is - you know, when I had to go to the emergency room over the summer, you know, this is something I worried about. You know, I was seeing a doctor who worked for the hospital, but they were sending off my ultrasound to be read by a radiologist who I was never going to meet. I couldn't ask them if they were in-network. I just kind of had to cross my fingers and hope for the best, and luckily, I didn't get a surprise bill.

But I've talked to multiple patients who, you know, tried to do their research, who thought they were in network, only to get a bill, often for thousands of dollars, after leaving the emergency room, from someone who, you know, never mentioned to them, hey, I'm not in your network like this hospital is.

GROSS: So the bill that you'd get would be for the difference between what you pay when somebody is - when a doctor's in network and what you pay when they're not in network?

KLIFF: Yeah, often it's just what that out-of-network doctor wants to charge. So a good example of this is a patient I wrote about in Texas named Scott (ph), who was attacked in downtown Austin, left on the street unconscious, some bystander called him an ambulance, and he woke up at a hospital. And one of the first things he does, because this is the United States, is he gets on his phone and tries to figure out which hospital he is at, and, you know, is that in his insurance network? And he finds out - good news - it is. And a surgeon comes by, tells him he's going to need emergency jaw surgery because of the attack that happened.

So he says, OK. You know, he's not really in a place to go anywhere. Gets the surgery. Goes home. A few weeks later, he gets an $8,000 bill from that oral surgeon, who the insurance companies paid a smaller amount. The oral surgeon didn't have a contract with the insurance and said, you know, I think my services are worth a lot more, so pursued the balance of the bill from Scott.

GROSS: I have to say, I mean, that does seem unfair to the patient because they haven't been informed. They can't make a choice about it if they don't know. And, like, $8,000 is a lot of money.

KLIFF: Yeah. And I think, you know, even more, let's say he did say he was out of network. It kind of puts the patient in an unfair situation, too. You know, one of the things we talk about a lot in health policy is, what if we had more transparency? What if we let patients know the prices? What if we let patients know who is in and out of network? And that - it would be a good step.

But, you know, I think with someone like Scott, sitting in a hospital with a broken jaw, there's not much you can do with that information. He doesn't have, you know, the ability to go home, like, research, like, make an appointment with a new surgeon. So, you know, it'd be great if he knew that the doctor was out of network. It'd be even better if he had some kind of protections against those type of bills.

GROSS: What kind of protection could there be?

KLIFF: So we're actually seeing a lot of action on this in Congress. There's some pretty strong bipartisan support for tackling this specific issue and essentially holding the patient harmless. When there is a situation like Scott's, for example, where there's this $8,000 bill, that's really a dispute between a health insurance company and a doctor, where the doctor says, I want more money, the insurer says, I want to pay you less money. And what Congress wants to do - what a few states have already done with their laws - is said, you can't go to the patient for that money. You, the hospital, and you, the health insurance company, you have to get down to a table and work things out together.

And some state laws will set certain amounts that are allowed to be charged, other ones will force the insurance company and the hospital into an arbitration process. But the general concept is to take the patient out of this billing situation because, like you said, Terry, they really aren't in a position to negotiate. They aren't in a position to shop. They shouldn't be the ones who are left holding the bag at the end of the day.

GROSS: My guest is Sarah Kliff. She covers health policy for Vox. After a break, we'll talk more about why ER bills can have some unpleasant surprises, and she'll give us an update on Obamacare. And Maureen Corrigan will review two books about forgotten stories from Hollywood. I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF JESSICA WILLIAMS TRIO'S "KRISTEN")

GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with journalist Sarah Kliff, who covers health policy and how it affects people for Vox. For the past year and a half, she's been writing about why emergency room visits can be so expensive and the pricing so secretive and mysterious, as well as inconsistent from one hospital to the next. She collected over 1,000 bills and tracked down stories behind the billing. She interviewed many of the patients and the people behind the billing to decipher why ER bills can have some surprise costs.

Here's another surprise that often awaits people who go to emergency rooms - some insurance plans only cover true emergencies, and whether it is a true emergency is sometimes determined after the diagnosis is made. So how are you supposed to know before the diagnosis whether you're going to be categorized as a true emergency or not? Like, if you go to the hospital, you don't know if you have a broken bone or not.

KLIFF: Right.

GROSS: Somebody needs to X-ray it and tell you.

KLIFF: Right. The whole point you go to the emergency room is to help them figure out what the emergency is and what treatment you need. This is a policy that the insurance company Anthem has been pioneering for a few years. It's been in Kentucky. It's been in Georgia - a few other states. And, you know, I wrote about one patient out in Kentucky named Brittany, who - she was having really severe abdominal pain. She called her mom who is a nurse, and the nurse said, that might be appendicitis. You've got to get to the emergency room. Turns out it wasn't appendicitis. It was an ovarian cyst. She got it treated elsewhere later down the line.

And Anthem, you know, sent her a letter saying, we're not going to cover that visit because it was not a true emergency. She appealed it. Her appeal was denied. This is another one where, once I started asking them about it, the bill suddenly disappeared. But - and it seems like as Anthem has gotten more attention for this policy - they haven't announced it publicly, but some pretty compelling data The New York Times got their hands on suggest they've backed off this policy.

But it's just, you know - there are so many traps you can fall into going into an emergency room. It just feels like you're walking into this minefield, and this is kind of one of those mines that's lurking in there.

GROSS: Hospital pricing and emergency room pricing seems to vary so much from hospital to hospital. Are there, like, national guidelines that help determine what a hospital or a hospital emergency room charges for services? I mean, who decides, and why is there such a variation?

KLIFF: So hospital executives get to decide, and I think that is why there is such variation. There aren't really guidelines that they're following. You know, one thing you could do as a hospital executive - you could look at what Medicare charges - those prices are public - and, you know, maybe use that as a benchmark. There are some databases. There's one called FAIR Health, for example, where you could look and see, you know, some information on what local prices typically are. But in terms of, you know, what you want to charge, that's kind of up to you as someone running a hospital.

One of the things that's really, really unique about the United States, compared to our peer countries, is that we don't regulate health care prices. Nearly every other country in the developed world - they see health care something as, you know, akin to a utility that everyone needs, like electricity or water. It's so important that the government is going to step in and regulate the prices. That doesn't happen in the United States. You know, if you're a hospital, you just choose your prices. And, you know, that is, I think, why you see so much variation and why you see some really high prices in American health care.

GROSS: So what advice do you have for people who actually need an emergency room and don't want to get hit with a shocking bill afterwards?

KLIFF: Yeah, this is, you know, one of those questions - it just makes me a little frustrated that - 'cause this is the most common question I get - right? - is, how do I - how do we - how do I prevent a surprise bill? And I find it kind of upsetting that, you know, it has to be on the patient because honestly, there really isn't a great way to do this. I've talked to so many patients who tried so hard to avoid a big medical bill and weren't able to.

You know, there's certain things, yes, you can do. You can look up the network status of your hospital. You can try and badger each doctor you see about whether they are in network. You can try to be a really proactive patient, but I think that's just such a huge burden on people who are in, like, really emergent situations. And some people don't have that opportunity, you know, like Justin Zanders, the guy we were talking about earlier who was taken to a hospital while he was unconscious. I cannot think of anything he could've done to avoid that bill. It just was not possible.

GROSS: So your advice is, good luck.

KLIFF: Short of that, I mean, good luck. You know, I'm actually in the middle of reporting a story right now about people who have successfully negotiated down their bills. And, you know, you can certainly - if you do end up with a surprise bill, you can call up the hospital, see if there's a discount. Sometimes there will be. Sometimes there won't. You can call again. Customer service representatives - different ones - often offer you different discounts, I've learned from interviewing patients. You can ask for a prompt pay discount if you pay right away.

You can - you know, one health attorney who negotiates these a lot on behalf of patients - he says one of his favorite tactics is to choose the amount you want to pay; send a check with that amount; and in the note, write, paid in full; and hope they don't come after you after that. I have no idea if that works or not, but he says it works for his patients. But it's a mixed bag. And at the end of the day, the hospital has all the power. You can ask for discounts. You can ask nicely. You can ask angrily. It's up to the hospital if they want to grant you that or not.

GROSS: So what is the status of Obamacare now? You know, Republicans promised to repeal and replace. That didn't work out. So have Republicans given up on repeal and replace?

KLIFF: For the time, it seems pretty clear that repeal and replace is dead on arrival, especially with Democrats taking control of the House this year. Those proposals aren't being talked about as much. They're not really going anywhere. The one big thing we did see Republicans succeed at is repealing Obamacare's individual mandate, the requirement that all of us carry health insurance. That happened as part of the big tax package that passed at the end of 2017.

So we've seen, you know, President Trump, for example, essentially declare victory, declare that repealing the individual mandate is repealing Obamacare, so we're good on that goal. But, you know, generally, Obamacare is still standing. There are millions of people getting their coverage through the Affordable Care Act still today.

GROSS: So now that there's no individual mandate, conservative attorney generals are challenging Obamacare - the Affordable Care Act - and saying it's no longer constitutional after Congress's repeal of the individual mandate. Could you explain that?

KLIFF: Yeah, so this is a challenge that's come up through the courts in the past few months. Obamacare is constantly being challenged in court. It's been through multiple Supreme Court suits. This one - you know, it's a multiple-part argument, so I'll try my best to walk through it.

KLIFF: So essentially, it starts with the fact that the individual mandate - they weren't quite able to repeal it for boring technical reasons. But what they were able to do is change the fee for not having health insurance from $700 to $0. So it - in all practical terms, it feels like repealing it because there is no fee for not carrying health insurance. The individual mandate was upheld as a tax when the Supreme Court said, yes, this is constitutional. The government has a right to tax people. Now that there is no fee associated with not carrying health insurance, the conservative attorneys general who are bringing this case argue that it's not a tax anymore, and therefore, it is not constitutional. That whole defense that John Roberts wrote in 2012 is moot. So that's the first part of it.

They go even further and say the individual mandate is so core to the Affordable Care Act, it is not severable. And if you, the courts, rule the individual mandate unconstitutional, then you need to rule all of Obamacare unconstitutional. And the first judge who heard this case - he is a, you know, judge in a district court in Texas. He agreed with them. He agreed that - first step - that the individual mandate is no longer constitutional. And second step, that means that the entirety of Obamacare has to fall. This is now being appealed up to the 5th Circuit Court of Appeals.

And I will say there are a lot of critics of this case. There are a lot of people who were parties to previous Supreme Court challenges to Obamacare who think this is a bad legal argument and that it will not succeed. But it is already, you know, gone through the district court level. It's moving up to the appellate court level. It is something that is in the mix that could become a threat to the Affordable Care Act.

GROSS: Well, if it goes to the Supreme Court, it would be very interesting to see what Justice Roberts says since he voted for the ACA, saying that the individual mandate was a tax.

KLIFF: Yeah. You know, and I think where some legal scholars would see it shaking out is that the - someone like John Roberts, he might agree, OK, yeah, the individual mandate is unconstitutional, but would not make the leap to the second half of this, that the rest of the law has to fall.

I think one of the most compelling arguments against this case is that Congress knew what they were doing when they repealed the individual mandate. You know, they had the opportunity to repeal Obamacare. They didn't. They'd specifically took aim at this one specific part. So it feels like it might be a bit of a reach to argue that what Congress really meant to do was repeal all these other parts of the Affordable Care Act. But, you know, the Supreme Court is changing. We have a new justice. You know, we have a lot in the mix. So it's always an open question of how a decision like this could go.

GROSS: So correct me if I'm wrong here - the Department of Justice has sided with the conservative attorneys general who are challenging Obamacare, saying it's no longer constitutional, and I think that the Justice Department is also asking the judge to strike down the ACA's mandatory coverage of pre-existing conditions.

KLIFF: Yeah, that's right. So it's a kind of unusual situation. Usually, it's the Justice Department that is going to defend a federal law in court. But, you know, given the Trump administration's opposition to the Affordable Care Act, they have decided to side with the conservative attorneys general. They have a slightly different argument. They don't think all of Obamacare should fall if the mandate falls, but they do think some big parts, like you mentioned, the protections for pre-existing conditions, should be ruled unconstitutional if the mandate falls.

So this has led to a bit of an unusual situation where you've had this coalition of Democratic attorneys general step in and take over the case, basically saying that the federal government is going - is not going to defend the Affordable Care Act. We are going to defend the Affordable Care Act. So you have this coalition of Democratic attorneys general, led by the attorney general of California, stepping in and, you know, offering a defense as this case works its way up through the court system.

GROSS: Let's take a short break here, and then we'll talk some more. If you're just joining us, my guest is Sarah Kliff. She's senior policy correspondent at Vox, where she focuses on health policy. And she hosts the Vox podcast "The Impact," about how policy actually affects people. We'll be right back. This is FRESH AIR.

(SOUNDBITE OF THE WEE TRIO'S "LOLA")

GROSS: This is FRESH AIR. And if you're just joining us, my guest is Sarah Kliff, senior policy correspondent at Vox, where she focuses on health policy.

Do you think health insurance is shaping up to be a big issue in the 2020 campaign?

KLIFF: I do, and I think it's going to be a big issue both in the primary, where you're already seeing candidates get pressed on, should we still have private health insurance, and giving pretty different answers to that question.

And then I think one of the things you're also going to see is whoever is the Democratic nominee is probably going to run on Obamacare. They are going to point at the fact that President Trump tried to repeal the Affordable Care Act. That's pretty different than, you know, the 2012 election, where Democrats were pretty scared to run on Obamacare. It still wasn't popular. The benefits hadn't rolled out. In this past midterm and now again in the 2020 election, it seems pretty clear that Democrats are pretty excited to point out that Republicans wanted to repeal Obamacare. So I think it really will come up.

GROSS: What are some of the biggest falsehoods you've heard from politicians about health insurance costs or health insurance policy?

KLIFF: You know, one of the ones that's come up a lot is actually around the role of private health insurance. So I've - I don't know if it counts as a falsehood, but I think it's a bit of a misunderstanding of how health insurance often works is, you know, when I talk to single-payer supporters, most of them want to eliminate private insurance completely. They just don't think there is a role for it in the health care system.

And one of the things I think that's actually pretty interesting, when you look at any other country - you look at Canada, you look at the U.K., you look at France, which all have national health care systems - all of them have a private health insurance market, too. There are always some kind of gap in the system that the public insurance can't cover, where the government step - where the private industry steps in and offers coverage. In Canada, for example, their public health plan doesn't cover prescription drugs, so two-thirds of Canadians take out a private plan, often through their employer, like us, to cover prescription drugs, to cover their eyeglasses, to cover their dental. So I think that's a confusion I see a lot in the "Medicare for All" debate coming up right now.

I think the other thing I see a lot of confusion around - and we've talked about this a little bit with emergency room billing - is the role of transparency in health care. I see a lot of, you know, if we just made the prices public, like, that is what we need to do to fix the system, and I think that really misses the fact that, even if the prices were public, health care is so different from everything else we shop for. It might be - I think it is the only thing we purchase when we are unconscious.

GROSS: (Laughter).

KLIFF: And when you're unconscious, you're not really going to be great at price shopping. So I see that as, you know, a halfway solution that I often hear talked about here in Washington that would be great but is not going to suddenly result in, you know, prices dropping because they've been exposed in a spotlight.

GROSS: Is there a country that you think has a good health care model that we could borrow?

KLIFF: Oh, yeah. I've been thinking about this a lot lately actually. So I've gotten very interested in the Australia health care system, which is a little far away. But I think they're a really interesting model because they have a public system, everyone's enrolled in it, but they also really aggressively try and get people to buy a private plan, too, and that private plan will get you sometimes faster access to doctors, maybe a private room at a hospital.

It's really hard for me to see the U.S. creating a health care system, similar to Canada's actually, where you can't buy private insurance, where if you're rich or you're poor, everyone waits in the exact same queue, you can't jump to the front of the line. Because I think wealthier Americans have gotten so used to having really good access to health care that they would be very upset with a system like that.

I think Australia is a kind of interesting hybrid between, you know, where we're at in the U.S. right now and what Canada is like, where it says, yes, we're going to create a public system for everybody, but we're also going to have these private plans that compete against the public system. So I've become increasingly, you know, interested in how Australia's system works. And they have - about 47 percent of Australians are buying a private plan to cover the same benefits that the public plan does.

GROSS: So it's not supplemental. It's instead of.

KLIFF: Right. So it's very different from Canada. So in Canada, you can buy complementary insurance, you know, to cover the benefits the public plan doesn't but the government expressly outlaws supplemental insurance. You know, like, what people buy here to cover the gaps in Medicare, that is not allowed. You cannot buy your way to the front of the line in Canada.

One of my favorite sayings about the Canadian health care system is from a doctor in a book I read about Canadian health care is they said, you know, we're fine waiting in lines for health care in Canada as long as the rich people and the poor people have to wait in the exact same line. Their system is all about equality. And I just don't know that we're at a place as a country where we value the same sort of equality in our health care system.

GROSS: Is there any developed country around the world that has a system similar to ours with all these competing insurance companies and, you know, some government plans and, like, a thousand different bureaucracies that doctors have to deal with and that patients have to deal with?

KLIFF: Absolutely not. There's nothing like it. I mean, our system is so unique. I'd say the closest but it's not even close are a few countries that have national health care systems, but they do it through tightly regulated private health insurance plans. So if you look at, like, Netherlands or Israel, there isn't a government-run plan. Instead, in both countries, you actually have four tightly regulated health insurance plans that compete against each other for the citizens' business. I guess that's the closest, but that is so different from what we have here right now. There's really nothing like it in any developed country.

GROSS: Sarah Kliff, thank you so much for talking with us.

KLIFF: Well, thank you for having me.

GROSS: Sarah Kliff covers health policy for Vox, where you'll find her series about emergency room bills. After we take a short break, Maureen Corrigan will review two books about forgotten stories from Hollywood. This is FRESH AIR.

(SOUNDBITE OF GEORGE FENTON AND PHILHARMONIC ORCHESTRA'S "MISS SHEPHERD'S WALTZ")

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The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

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Urgent care vs. emergency room visit cost

$150 – $250 average urgent care visit cost (without insurance), $1,500 – $3,000 average er visit cost (without insurance).

Emergency room vs. urgent care cost

The average urgent care visit costs $150 to $250 without insurance, while an emergency room visit costs $1,500 to $3,000 for the same service. While you should go to the ER for serious health concerns, visiting an urgent care center is the best choice for most non-life-threatening health issues.

What's the difference between urgent care and the emergency room?

Urgent care centers are meant for illnesses and injuries that are not life-threatening. These same-day clinics also provide other healthcare services, like routine physicals, imaging, and lab tests.

The emergency room is intended for critical, life-threatening situations that need immediate attention, such as a major injury, heart attack, stroke, or uncontrollable bleeding.

Cost comparison for common conditions

Many people go to the ER for health concerns that could be handled at an urgent care center for much cheaper. The cost of an urgent care visit is typically much less than the cost of an emergency room visit to treat the same ailment.

The table below shows the average costs for common conditions treated at an urgent care center or the ER.

If you have health insurance, your urgent care visit copay may be higher than your copay to see a primary care doctor but will likely be less than the out-of-pocket cost for an ER visit.

When to go to urgent care vs. the emergency room

Research shows 30% to 50%+ of emergency room patients could have been treated at an urgent care facility, often at a much lower cost. With healthcare prices constantly increasing, consider your options to make the best decision for your situation.

Call 9-1-1 or go to the ER for any serious, potentially life-threatening symptoms, such as:

Fever that does not resolve with over-the-counter medicine

Major broken bones

Trouble breathing

Serious head injury

Severe allergic reaction

Severe burn

Signs of a heart attack or stroke

Sudden severe pain

Sudden change in vision

Sudden confusion

Suddenly feeling weak or unable to move, speak, or walk

Uncontrollable bleeding

Consider an urgent care facility if you are experiencing a non-critical health issue and your primary doctor's office is closed or cannot fit you into the schedule. Urgent care centers can handle most non-emergency healthcare services, including:

Treatment for minor illnesses and injuries

Physicals needed for sports, school, or employment

Diagnostic lab testing

Medications

Medical equipment

Tips to save on urgent care and ER costs

No matter where you get treated, healthcare bills can add up quickly, even if you have insurance. Here are some guidelines to ensure you don't overpay for your care:

Assess your situation before heading straight to the ER. If your health issue is not life threatening, consider going to an urgent care center instead as the cost for the same services can be much lower.

If you do need emergency care, go to a hospital-based ER when possible. Freestanding ER centers typically cost more than hospital-based emergency rooms.

Call ahead to confirm the current wait time, costs, and payment options. Many urgent care centers require payment at the time of service.

Consider asking the following questions up front to prevent surprises in your bill:

Do you have discounted pricing for uninsured patients?

Do you work with any charitable organizations that could help with my costs?

Will this cost less if I pay with cash?

What will the cost be for my specific issue?

Do you think I will need lab tests or scans, and what will they cost?

How much do you charge for X-rays and imaging?

If I need medication, how much will it cost?

We use our proprietary database of project costs, personally contact industry experts to compile up-to-date pricing and insights, and conduct in-depth research to ensure accuracy in all our guides.

Does Medicare cover emergency room visits?

Published by Medicare Made Clear®

Yes, Medicare covers emergency room visits for injuries, sudden illnesses or an illness that gets worse quickly. Specifically, Medicare Part B will cover ER visits. And, since emergencies may occur anytime and anywhere, Medicare coverage for ER visits applies to any ER or hospital in the country. Note though, Medicare only covers emergency services in foreign countries in select situations.

How much does an ER visit cost?

Medicare typically charges a copay for each emergency room visit and copays for hospital services you receive during the visit. In addition to these copays, you will pay a coinsurance for doctor services you receive in the ER. Medicare Part B typically pays 80 percent of the Medicare-approved amount for doctor services, and you are responsible for the remaining 20 percent of the cost. The Part B deductible also applies.

The total amount you actually pay for an ER visit will depend on the type of facility you go to, whether you have other insurance, such as a Medicare supplement plan (Medigap) or a Medicare Advantage plan (Part C), and other factors.

Costs can change if you are admitted to the hospital

If an ER visit results in being you admitted to the hospital, then the visit is considered part of an inpatient stay and ER-related copays would not apply. To qualify as such, a hospital admission must happen within three days of the ER visit for the same or a related condition, and it must be at the hospital where ER services were provided. Admission to a different hospital within three days, even for the same condition, would be considered a separate event.

Does Medicare Advantage cover ER visits?

Medicare Advantage plans cover ER visits – and everything else that Original Medicare (Parts A & B) covers. By law, these plans must offer coverage equal to or better than what Original Medicare provides. So, though Medicare Advantage plans typically have provider networks, they must cover emergency care from both network and out-of-network providers. In other words, Medicare Advantage plans cover ER visits anywhere in the U.S.

Each Medicare Advantage plan sets its own cost terms for ER visits and other covered services. For example, you may pay copays or coinsurance for an ER visit and for services you receive while in the ER. Some plans also have deductibles. It’s important to check each plan’s details for information about coverage for ER visits.

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Emergency department services

Medicare Part B (Medical Insurance)  usually covers emergency department services when you have an injury, a sudden illness, or an illness that quickly gets much worse.

Your costs in Original Medicare

• You pay a  copayment for each emergency department visit and a copayment for each hospital service you get.
• After you meet the Part B deductible , you also pay 20% of the  Medicare-Approved Amount  for your doctor's services.
• If your doctor admits you to the same hospital for a related condition within 3 days of your emergency department visit, you don't pay the copayment(s) because your visit is considered part of your inpatient stay.   

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Things to know

Medicare only covers emergency services in foreign countries under rare circumstances.

Related resources

• Ambulance services
• Find hospitals
• Inpatient hospital care
• Outpatient hospital services

Is my test, item, or service covered?

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Costs of Emergency Department Visits By Age

Costs of Emergency Department Visits By Age (PDF, 1.6 MB)

Source: HCUP Statistical Brief #268, Costs of Emergency Department Visits in the United States, 2017  ( PDF , 326 KB). View the list of HCUP Data Partners .

Internet Citation: Costs of Emergency Department Visits By Age. Content last reviewed March 2021. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/data/infographics/costs-ed-visits.html

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Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-.

Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet].

Statistical brief #268 costs of emergency department visits in the united states, 2017.

Brian J. Moore , Ph.D. and Lan Liang , Ph.D.

Published: December 8, 2020 .

• Introduction

Emergency department (ED) visits have grown in the United States, with the rate of increase from 1996 to 2013 exceeding that for hospital inpatient care. 1 In 2017, 13.3 percent of the U.S. population incurred at least one expense for an ED visit. 2 Furthermore, more than 50 percent of hospital inpatient stays in 2017 included evidence of ED services prior to admission. 3 Trends in ED volume vary significantly by patient and hospital characteristics, but an examination of nationwide costs by these characteristics has not yet been explored in the literature. 4

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents statistics on the cost of ED visits in the United States using the 2017 Nationwide Emergency Department Sample (NEDS). Total ED charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS). ED visits include patients treated and released from the ED, as well as those admitted to the same hospital through the ED. Aggregate costs, average costs, and number of ED visits are presented by patient and hospital characteristics. Because of the large sample size of the NEDS data, small differences can be statistically significant. Thus, only percentage differences greater than or equal to 10 percent are discussed in the text.

• There were 144.8 million total emergency department (ED) visits in 2017 with aggregate ED costs totaling $76.3 billion (B).
• Aggregate ED costs were higher for females ($42.6B, 56 percent) than males ($33.7B, 44 percent); 55 percent of total ED visits were for females.
• Average cost per ED visit increased with age, from $290 for patients aged 17 years and younger to $690 for patients aged 65 years and older.
• As community-level income increased, shares of aggregate ED costs decreased and average cost per visit increased.
• In rural areas, one half of ED visit costs were for patients from the lowest income communities.
• The expected payer with the largest share of aggregate costs was private insurance in large metropolitan areas (31.4 percent of $39.5B) and Medicare in micropolitan (34.0 percent of $7.6B) and rural (37.3 percent of $5.5B) areas.
• Patients aged 18–44 years represented the largest share of aggregate ED costs in large metropolitan, small metropolitan, and micropolitan areas (36.4, 34.2, 32.5 percent, respectively). Patients aged 65 years and older represented the largest share of aggregate ED costs in rural areas (32.5 percent).

Aggregate costs for emergency department (ED) visits by patient sex and age group, 2017

Figure 1 presents aggregate ED visit costs by patient sex and age group in 2017 as well as number of ED visits. Estimates of aggregate cost use the product of the number of cases and the average estimated cost per visit to account for records with missing ED charge information. Aggregate cost decompositions among different descriptive statistics or using multiple levels of aggregation in a single computation could lead to slightly different total cost estimates due to the use of slightly different and more specific estimates of the missing information.

Aggregate ED visit costs by patient sex and age, 2017. Abbreviation: ED, emergency department Notes: Statistics for ED visits with missing or invalid patient characteristics are not presented. Patient age and sex were each missing for <0.1% of (more...)

• Aggregate ED visit costs in 2017 were higher overall for females than for males. Of the $76.3 billion in aggregate ED visit costs in 2017, females accounted for $42.6 billion (55.9 percent) and males accounted for $33.7 billion (44.1 percent). This cost differential was largely driven by a difference in ED visit volume, with females having a larger number of ED visits than males (80.2 vs. 64.6 million visits, or 55.4 vs. 44.6 percent of visits). Females had higher aggregate ED visit costs and more ED visits for all age groups except children. The discrepancy was highest for patients aged 18–44 years, with aggregate ED visit costs for females approximately 50 percent higher than costs for males ($15.9 vs. $10.7 billion), followed by patients aged 65 years and older, for which aggregate ED visit costs were approximately one-third higher for females than for males ($11.5 vs. $8.6 billion).

Costs of ED visits by patient characteristics, 2017

Table 1 presents the aggregate and average costs for ED visits, the number of ED visits, and the distributions of costs and visits, by select patient characteristics in 2017.

Aggregate costs, average costs, and number of ED visits by patient characteristics, 2017.

• In 2017, aggregate ED visit costs totaled $76.3 billion across 144.8 million ED visits, with an average cost per visit of $530. Aggregate ED visit costs totaled $76.3 billion in the United States in 2017, encompassing 144.8 million ED visits with an average cost per visit of $530. Routine discharge was the most frequent disposition from the ED, representing 80.8 percent of aggregate ED costs and a similar share of ED visits. Transfers represented 6.2 percent of aggregate ED costs but just 3.0 percent of ED visit volume because they had the highest average cost of any discharge disposition at $1,100 per ED visit. In contrast, ED visits resulting in an inpatient admission to the same hospital had the lowest average cost of any discharge disposition at $360 per ED visit and represented 9.4 percent of aggregate ED costs and 14.0 percent of ED visits.
• The share of aggregate ED visit costs attributed to patients aged 65 years and older was higher than the share of ED visits for this group, and the average cost per visit was highest among patients aged 65 years and older. Aggregate ED visit costs among patients aged 65 years and older totaled $20.2 billion (26.4 percent of the $76.3 billion total for the entire United States in 2017) despite just 29.2 million ED visits from patients in this age group (20.2 percent of the 144.8 million total). Conversely, the share of aggregate ED costs attributed to patients aged 17 years and younger was substantially lower than this group’s corresponding share of ED visits (10.3 percent of ED costs vs.18.5 percent of ED visits). This differential is due in part to the difference in average cost per visit, which increased with age. The average cost per visit among patients aged 65 years and older was more than twice as high as average costs among patients aged 17 years and younger ($690 vs. $290 per visit).
• Medicaid as the primary expected payer had the lowest average cost per ED visit, more than 50 percent lower than average costs for Medicare and one-third lower than for private insurance. Medicaid as the primary expected payer had an average cost per ED visit that was more than 50 percent lower than average costs per visit for Medicare ($420 vs. $660 per visit) and one-third lower than average costs for private insurance ($420 vs. $560 per visit). Due in part to these differences in average costs by expected payer, Medicare represented 30.1 percent of aggregate ED visit costs but 24.1 percent of total ED visits. In contrast, Medicaid represented 25.0 percent of ED costs but 31.5 percent of ED visits.
• As community-level income increased, the share of aggregate ED visit costs decreased and average cost per ED visit increased. The share of ED visit costs and ED visits decreased as community-level income increased. Patients residing in communities with the lowest income (quartile 1) represented roughly one-third of aggregate ED visit costs and ED visits (31.4 and 34.3 percent, respectively). Patients residing in quartiles 2 and 3 represented approximately one-fourth and one-fifth of aggregate ED visit costs and ED visits, respectively. Patients residing in communities with the highest income (quartile 4) represented less than one-fifth of aggregate ED costs and ED visits (18.1 and 16.0 percent, respectively). In contrast, average cost per ED visit increased as community-level income increased, ranging from $480 in communities with the lowest income (quartile 1) to $600 in communities with the highest income (quartile 4).
• The share of aggregate ED visit costs was highest among patients residing in large metropolitan areas. Aggregate ED visit costs for large metropolitan areas totaled $39.5 billion in 2017, more than half of the $76.3 billion in ED costs for the entire United States. The share of aggregate ED costs in large metropolitan areas was analogous to the overall distribution of ED visits in these areas: 51.8 percent of aggregate ED costs and 50.4 percent of ED visits.

Distribution of aggregate ED visit costs for location of patient residence by patient characteristics, 2017

Figures 2 – 4 present the distribution of aggregate costs for ED visits based on the location of the patient’s residence by age ( Figure 2 ), community-level income ( Figure 3 ), and primary expected payer ( Figure 4 ).

Aggregate ED visit costs by age and patient location, 2017. Abbreviations: B, billion; ED, emergency department; M, million Notes: Statistics for ED visits with missing or invalid patient characteristics are not presented. Patient age and patient location (more...)

Aggregate ED visit costs by primary expected payer and patient location, 2017. Abbreviations: B, billion; ED, emergency department; M, million Notes: Statistics for ED visits with missing or invalid patient characteristics are not presented. Expected (more...)

Aggregate ED visit costs by community-level income and location of patient’s residence, 2017. Abbreviations: B, billion; ED, emergency department; M, million Notes: Statistics for ED visits with missing or invalid patient characteristics are not (more...)

Figure 2 presents the distribution of aggregate costs for ED visits by patient age based on the location of the patient’s residence in 2017.

• Patients aged 18–44 years represented the largest share of aggregate ED visit costs in all locations except rural areas where patients aged 65 years and older represented the largest share. Compared with other age groups, patients aged 18–44 years represented the largest share of aggregate ED visit costs in large metropolitan areas in 2017 (36.4 percent). The share of ED costs attributed to patients aged 18–44 years also was larger than for other age groups in small metropolitan and micropolitan areas (34.2 and 32.5 percent, respectively). Overall, the share of ED costs attributed to patients aged 18–44 years decreased as urbanization decreased, from 36.4 percent in large metropolitan areas to 29.8 percent in rural areas. In rural areas, patients aged 65 years and older accounted for the largest share of aggregate ED visit costs (32.5 percent) compared with other age groups. The share of ED costs attributed to patients aged 65 years and older increased as urbanization decreased, from 24.7 percent in large metropolitan areas to 32.5 percent in rural areas. The share of aggregate ED visit costs attributed to patients aged 45–64 years and those aged 17 years and younger were similar across all patient locations (approximately 28 and 10 percent, respectively).

Figure 3 presents the distribution of aggregate costs for ED visits by quartile of community-level household income in the patient’s ZIP Code based on the location of the patient’s residence in 2017.

• In large metropolitan areas, patients residing in communities with the highest and lowest incomes represented the largest shares of aggregate ED visit costs. For other locations, patients in communities with lower incomes represented the largest share of ED costs. Patients residing in communities with the highest and lowest incomes (quartiles 4 and 1) accounted for 28.1 and 26.6 percent, respectively, of the $39.5 billion in aggregate ED visit costs in large metropolitan areas in 2017. In contrast, patients residing in communities with the two lowest income quartiles represented the largest share of ED costs for other patient locations (small metropolitan, micropolitan, and rural).
• As urbanization decreased, the share of aggregate ED visit costs for patients in the lowest income quartile increased and the share for those in the highest income quartile decreased. The share of aggregate ED visit costs attributed to patients residing in communities in the lowest income quartile (quartile 1) increased as urbanization decreased, from 26.6 percent in large metropolitan areas to 48.8 percent in rural areas. In contrast, the share of ED visit costs attributed to patients residing in communities in the highest income quartile (quartile 4) decreased as urbanization decreased, from 28.1 percent in large metropolitan areas to 1.2 percent in rural areas.

Figure 4 presents the distribution of aggregate costs for ED visits by primary expected payer based on the location of the patient’s residence in 2017.

• Private insurance as the primary expected payer accounted for the largest share of aggregate ED visit costs among patients living in large metropolitan areas. Medicare represented the largest share of ED costs in micropolitan and rural areas. Compared with other primary expected payers, private insurance represented the largest share of aggregate ED visit costs among those living in large metropolitan areas in 2017 (31.4 percent). The share of ED costs attributed to private insurance decreased as urbanization decreased, from 31.4 percent in large metropolitan areas to 27.9 percent in rural areas. More than one-third of ED visit costs were attributed to Medicare as the primary expected payer in micropolitan and rural areas. The share of ED costs attributed to Medicare increased as urbanization decreased, from 28.0 percent in large metropolitan areas to 37.3 percent in rural areas.

Costs of ED visits by hospital characteristics, 2017

Table 2 presents the aggregate and average costs for ED visits, the number of ED visits, and the distributions of costs and visits, by select hospital characteristics in 2017.

Aggregate costs, average costs, and number of ED visits by hospital characteristics, 2017.

• Aggregate ED visit costs were highest for hospitals located in the South in 2017. Aggregate ED visit costs in the South were $27.5 billion in 2017 (36.1 percent of the total $76.3 billion for the United States). The share of ED visit volume for the South was even larger (40.0 percent of the 144.8 million total visits). The distribution of aggregate ED visit costs across other hospital characteristics largely followed the pattern of the number of ED visits. Aggregate ED costs were highest in private, nonprofit hospitals; teaching hospitals; and hospitals not designated as a trauma center (72.0, 64.1, and 52.5 percent of ED costs, respectively). ED visits at private, for-profit hospitals had lower average costs per visit than did visits at either private, nonprofit or public hospitals ($420 vs. $540 and $550 per visit).
• About Statistical Briefs

Healthcare Cost and Utilization Project (HCUP) Statistical Briefs provide basic descriptive statistics on a variety of topics using HCUP administrative healthcare data. Topics include hospital inpatient, ambulatory surgery, and emergency department use and costs, quality of care, access to care, medical conditions, procedures, and patient populations, among other topics. The reports are intended to generate hypotheses that can be further explored in other research; the reports are not designed to answer in-depth research questions using multivariate methods.

• Data Source

The estimates in this Statistical Brief are based upon data from the HCUP 2017 Nationwide Emergency Department Sample (NEDS).

• Definitions

Types of hospitals included in the HCUP Nationwide Emergency Department Sample

The Nationwide Emergency Department Sample (NEDS) is based on emergency department (ED) data from community acute care hospitals, which are defined as short-term, non-Federal, general, and other specialty hospitals available to the public. Included among community hospitals are pediatric institutions and hospitals that are part of academic medical centers. Excluded are long-term care facilities such as rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals. Hospitals included in the NEDS have EDs, and no more than 90 percent of their ED visits result in admission.

Unit of analysis

The unit of analysis is the ED visit, not a person or patient. This means that a person who is seen in the ED multiple times in 1 year will be counted each time as a separate visit in the ED.

Costs and charges

Total ED charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS). a Costs reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case. For each hospital, a cost-to-charge ratio constructed specifically for the hospital ED is used. Hospital charges reflect the amount the hospital billed for the entire ED visit and do not include professional (physician) fees.

Total charges were not available on all NEDS records. About 13 percent of all ED visits (weighted) in the 2017 NEDS were missing information about ED charges, and therefore, ED cost could not be estimated. For ED visits that resulted in admission, 24 percent of records were missing ED charges. For ED visits that did not result in admission, 11 percent of records were missing ED charges. The missing information was concentrated in the West (59 percent of records missing ED charges). For this Statistical Brief, the methodology used for aggregate cost estimation was analogous to what is recommended for the estimation of aggregate charges in the Introduction to the HCUP NEDS documentation. b Aggregate costs were estimated as the product of number of visits and average cost per visit in each reporting category. If a stay was missing total charges, average cost was imputed using the average cost for other stays with the same combination of payer characteristics. Therefore, a comparison of aggregate cost estimates across different tables, figures, or characteristics may result in slight discrepancies.

How HCUP estimates of costs differ from National Health Expenditure Accounts

There are a number of differences between the costs cited in this Statistical Brief and spending as measured in the National Health Expenditure Accounts (NHEA), which are produced annually by CMS. c The largest source of difference comes from the HCUP coverage of ED treatment only in contrast to the NHEA inclusion of inpatient and other outpatient costs associated with other hospital-based outpatient clinics and departments as well. The outpatient portion of hospitals’ activities has been growing steadily and may exceed half of all hospital revenue in recent years. On the basis of the American Hospital Association Annual Survey, 2017 outpatient gross revenues (or charges) were about 49 percent of total hospital gross revenues. d

Smaller sources of differences come from the inclusion in the NHEA of hospitals that are excluded from HCUP. These include Federal hospitals (Department of Defense, Veterans Administration, Indian Health Services, and Department of Justice [prison] hospitals) as well as psychiatric, substance abuse, and long-term care hospitals. A third source of difference lies in the HCUP reliance on billed charges from hospitals to payers, adjusted to provide estimates of costs using hospital-wide cost-to-charge ratios, in contrast to the NHEA measurement of spending or revenue. HCUP costs estimate the amount of money required to produce hospital services, including expenses for wages, salaries, and benefits paid to staff as well as utilities, maintenance, and other similar expenses required to run a hospital. NHEA spending or revenue measures the amount of income received by the hospital for treatment and other services provided, including payments by insurers, patients, or government programs. The difference between revenues and costs includes profit for for-profit hospitals or surpluses for nonprofit hospitals.

Location of patients’ residence

Place of residence is based on the urban-rural classification scheme for U.S. counties developed by the National Center for Health Statistics (NCHS) and based on the Office of Management and Budget (OMB) definition of a metropolitan service area as including a city and a population of at least 50,000 residents. For this Statistical Brief, we collapsed the NCHS categories into four groups according to the following:

Large Metropolitan

• Large Central Metropolitan: Counties in a metropolitan area with 1 million or more residents that satisfy at least one of the following criteria: (1) containing the entire population of the largest principal city of the metropolitan statistical area (MSA), (2) having their entire population contained within the largest principal city of the MSA, or (3) containing at least 250,000 residents of any principal city in the MSA
• Large Fringe Metropolitan: Counties in a metropolitan area with 1 million or more residents that do not qualify as large central metropolitan counties

Small Metropolitan

• Medium Metropolitan: Counties in a metropolitan area of 250,000–999,999 residents
• Small Metropolitan: Counties in a metropolitan area of 50,000–249,999 residents

Micropolitan:

• Micropolitan: Counties in a nonmetropolitan area of 10,000–49,999 residents
• Noncore: Counties in a nonmetropolitan and nonmicropolitan area

Community-level income

Community-level income is based on the median household income of the patient’s ZIP Code of residence. Quartiles are defined so that the total U.S. population is evenly distributed. Cut-offs for the quartiles are determined annually using ZIP Code demographic data obtained from Claritas, a vendor that produces population estimates and projections based on data from the U.S. Census Bureau. e The value ranges for the income quartiles vary by year. The income quartile is missing for patients who are homeless or foreign.

Expected payer

• Medicare: includes fee-for-service and managed care Medicare
• Medicaid: includes fee-for-service and managed care Medicaid
• Private insurance: includes commercial nongovernmental payers, regardless of the type of plan (e.g., private health maintenance organizations [HMOs], preferred provider organizations [PPOs])
• Self-pay/No charge: includes self-pay, no charge, charity, and no expected payment
• Other payers: includes other Federal and local government programs (e.g., TRICARE, CHAMPVA, Indian Health Service, Black Lung, Title V) and Workers’ Compensation

ED visits that were expected to be billed to the State Children’s Health Insurance Program (SCHIP) are included under Medicaid.

• Northeast: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania
• Midwest: Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas
• South: Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas
• West: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Alaska, and Hawaii

Discharge status

Discharge status reflects the disposition of the patient at discharge from the ED and includes the following categories reported in this Statistical Brief: routine (to home); admitted as an inpatient to the same hospital; transfers (transfer to another short-term hospital; other transfers including skilled nursing facility, intermediate care, and another type of facility such as a nursing home); and all other dispositions (home healthcare; against medical advice [AMA]; died in the ED; or destination unknown).

Hospital characteristics

Data on hospital ownership and status as a teaching hospital was obtained from the American Hospital Association (AHA) Annual Survey of Hospitals. Hospital ownership/control includes categories for government nonfederal (public), private not-for-profit (voluntary), and private investor-owned (proprietary). Teaching hospital is defined as having a residency program approved by the American Medical Association, being a member of the Council of Teaching Hospitals, or having a ratio of full-time equivalent interns and residents to beds of 0.25 or higher.

Hospital trauma level

• Level I centers have comprehensive resources, are able to care for the most severely injured, and provide leadership in education and research.
• Level II centers have comprehensive resources and are able to care for the most severely injured, but do not provide leadership in education and research.
• Level III centers provide prompt assessment and resuscitation, emergency surgery, and, if needed, transfer to a level I or II center.
• Level IV/V centers provide trauma support in remote areas in which no higher level of care is available. These centers resuscitate and stabilize patients and arrange transfer to an appropriate trauma facility.

For this Statistical Brief, trauma hospitals were defined as those classified by the ASC/COT as a level I, II, or III trauma center. This is consistent with the classification of trauma centers used in the NEDS. The ACS/COT has a program that verifies hospitals as trauma level I, II, or III. h It is important to note that although all level I, II, and III trauma centers offer a high level of trauma care, there may be differences in the specific services and resources offered by hospitals of different levels. Trauma levels IV and V are designated at the State level (and not by ACS/COT) with varying criteria applied across States.

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, and private data organizations (HCUP Partners) and the Federal government to create a national information resource of encounter-level healthcare data. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to healthcare programs, and outcomes of treatments at the national, State, and local market levels.

• Alaska Department of Health and Social Services
• Alaska State Hospital and Nursing Home Services Association
• Arizona Department of Health Services
• Arkansas Department of Health
• California Office of Statewide Health Planning and Development
• Colorado Hospital Association
• Connecticut Hospital Association
• Delaware Division of Public Health
• District of Columbia Hospital Association
• Florida Agency for Health Care Administration
• Georgia Hospital Association
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• Hawaii University of Hawai’i at Hilo
• Illinois Department of Public Health
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• Massachusetts Center for Health Information and Analysis
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• About the NEDS

The HCUP Nationwide Emergency Department Sample (NEDS) is a unique and powerful database that yields national estimates of emergency department (ED) visits. The NEDS was constructed using records from both the HCUP State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID). The SEDD capture information on ED visits that do not result in an admission (i.e., patients who were treated in the ED and then released from the ED, or patients who were transferred to another hospital); the SID contain information on patients initially seen in the ED and then admitted to the same hospital. The NEDS was created to enable analyses of ED utilization patterns and support public health professionals, administrators, policymakers, and clinicians in their decision making regarding this critical source of care. The NEDS is produced annually beginning in 2006. Over time, the sampling frame for the NEDS has changed; thus, the number of States contributing to the NEDS varies from year to year. The NEDS is intended for national estimates only; no State-level estimates can be produced. The unweighted sample size for the 2017 NEDS is 33,506,645 (weighted, this represents 144,814,803 ED visits).

• For More Information

For other information on emergency department visits, refer to the HCUP Statistical Briefs located at www.hcup-us.ahrq.gov/reports/statbriefs/sb_ed.jsp .

• HCUP Fast Stats at www.hcup-us.ahrq.gov/faststats/landing.jsp for easy access to the latest HCUP-based statistics for healthcare information topics
• HCUPnet, HCUP’s interactive query system, at www.hcupnet.ahrq.gov/

For more information about HCUP, visit www.hcup-us.ahrq.gov/ .

For a detailed description of HCUP and more information on the design of the Nationwide Emergency Department Sample (NEDS), please refer to the following database documentation:

Agency for Healthcare Research and Quality. Overview of the Nationwide Emergency Department Sample (NEDS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality. Updated December 2019. www.hcup-us.ahrq.gov/nedsoverview.jsp . Accessed February 3, 2020.

• Acknowledgments

The authors would like to acknowledge the contributions of Nils Nordstrand of IBM Watson Health.

The HCUP Cost-to-Charge Ratios (CCRs) for NEDS Files were not publicly available at the time of publication, so an internal version was used in this Statistical Brief.

Agency for Healthcare Research and Quality. HCUP Nationwide Emergency Department Sample (NEDS) Database Documentation. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality. Updated April 27, 2020. www ​.hcup-us.ahrq.gov ​/db/nation/neds/nedsdbdocumentation.jsp . Accessed October 27, 2020.

For additional information about the NHEA, see Centers for Medicare & Medicaid Services (CMS). National Health Expenditure Data. CMS website. Updated December 17, 2019. www ​.cms.gov/Research-Statistics-Data-and-Systems ​/Statistics-Trends-and-Reports ​/NationalHealthExpendData/index ​.html?redirect= ​/NationalHealthExpendData/ . Accessed February 3, 2020.

American Hospital Association. TrendWatch Chartbook, 2019. Table 4.2. Distribution of Inpatient vs. Outpatient Revenues, 1995–2017. www ​.aha.org/system/files ​/media/file/2019 ​/11/TrendwatchChartbook-2019-Appendices ​.pdf . Accessed March 19, 2020.

Claritas. Claritas Demographic Profile by ZIP Code. https://claritas360.claritas.com/mybestsegments/. Accessed February 3, 2020.

American Trauma Society. Trauma Information Exchange Program (TIEP). www ​.amtrauma.org/page/TIEP . Accessed June 11, 2020.

MacKenzie EJ, Hoyt DB, Sacra JC, Jurkovich GJ, Carlini AR, Teitelbaum SD, et al. National inventory of hospital trauma centers. JAMA. 2003;289(12):1515–22. [ PubMed : 12672768 ]

American College of Surgeons Committee on Trauma, Verification, Review, and Consultation Program for Hospitals. Additional details are available at www ​.facs.org/quality-programs/trauma/vrc . Accessed July 17, 2020.

Moore BJ (IBM Watson Health), Liang L (AHRQ). Costs of Emergency Department Visits in the United States, 2017. HCUP Statistical Brief #268. December 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb268-ED-Costs-2017.pdf .

• Cite this Page Moore BJ, Liang L. Costs of Emergency Department Visits in the United States, 2017. 2020 Dec 8. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-. Statistical Brief #268.
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In this Page

• Healthcare Cost and Utilization Project (HCUP)
• Nationwide Inpatient Sample (NIS)
• Kids' Inpatient Database (KID)
• Nationwide Emergency Department Sample (NEDS)
• State Inpatient Databases (SID)
• State Ambulatory Surgery Databases (SASD)
• State Emergency Department Databases (SEDD)
• HCUP Overview
• HCUP Fact Sheet
• HCUP Partners
• HCUP User Support

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

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Does Medicare cover emergency room visits?

Going to the emergency room (ER) can be stressful. To give you some peace of mind, let’s review what Medicare covers for ER visits.

Original Medicare Part B (medical insurance) generally covers ER visits

Medicare Part B usually covers emergency department services when you have an injury, a sudden illness or an illness that gets worse quickly. 1

If Medicare Part B does pay some of the ER costs, you still pay: 1

• A copayment for each ER visit
• A copayment for each hospital service
• 20% of the Medicare-approved amount for your doctor’s services
• The Part B deductible ($240 in 2024)

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Humana Medicare Advantage plans offer benefits beyond what Original Medicare covers. Explore all of the plans available in your area!

Other Parts of Medicare that help pay for ER visits

Original medicare part a (hospital insurance).

ER visits are considered outpatient stays, and Medicare Part A does not cover outpatient stays. However, if you’re formally admitted to the hospital with a doctor’s order, Part A will help pay for your inpatient hospital stay. It will also pay for related outpatient services provided during the 3 days before your admission date. 2

Note: You’ll still be responsible for your deductible, coinsurance and copayments.

Medicare Part C (Medicare Advantage plans)

At a minimum, Medicare Advantage plans offer the same ER coverage as Original Medicare (Parts A and B). But, some Medicare Advantage plans may offer extra coverage for ER visits. If you get your Medicare coverage through a Medicare Advantage plan, check with your provider for details.

Note: You’ll still be responsible for your deductible, coinsurance, copayments and your Medicare Advantage plan monthly premium.

Medicare Part D (prescription drug plans)

Medicare Part D plans help pay for prescription medications. If you have a prescription drug plan and receive medication in the ER that’s on your list of covered medications, Part D prescription drug coverage may help pay for it.

Medicare Supplement plans (Medigap)

Medicare Supplement plans help cover out-of-pocket expenses for Original Medicare. Some Medigap plans pay for all or part of Part B’s coinsurances or copayments, which can lower the costs of an ER visit. If you have a Medigap plan, check with your provider for details.

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• “ Emergency department services ,” Medicare.gov, last accessed December 29, 2023.
• “ Differences Between Inpatient, Outpatient, and Under Observation ,” eHealth, last accessed December 29, 2023.

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Does Medicare Part A cover emergency room visits?

Medicare Part A does not usually cover emergency room visits unless a doctor admits a person to stay in the hospital as an inpatient. Medicare Part B covers outpatient emergency room visits.

This means that an insured person would need to meet their annual deductible of $198 before Medicare pays for emergency room (ER) visits. Coinsurance of 20% also applies to each visit.

In this article, we expand on which parts of Medicare pay for an ER visit and the costs a person is responsible for under Medicare.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan: Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments. Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%. Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Which part of Medicare covers ER visits?

Medicare determines which portion of Medicare funds an ER visit based on the doctor’s decision to admit an insured person to the hospital as an inpatient.

Admitting a person as an inpatient means that they need further interventions and medical care before they can return home.

Around 139 million people visited an emergency room in 2017, according to the Centers for Disease Control and Prevention (CDC) .

An estimated 14.5 million of those who made an emergency room visit needed hospital admission. This roughly equates to 10.4% of all emergency room visits.

If a person visits the emergency room without needing admission, Medicare Part B covers a portion of the costs. Part A pays if a person visits the ER, and a doctor admits them to the hospital.

What does Part A cover?

Medicare Part A covers hospital or inpatient care.

A person usually visits the ER at a hospital. However, there is a difference between emergency care at a hospital and being a hospital inpatient.

Medicare Part A specifically covers care when a person stays as an inpatient at the hospital. Medicare considers a person an inpatient when their stay has extended beyond two midnights .

If a doctor admits a person to the hospital, the law requires that they notify the individual that they are an inpatient.

What does Part A not cover?

Medicare Part A covers several services, including inpatient hospital care, skilled nursing facility (SNF) care, and hospice care.

However, this part of Medicare does not cover other services that relate to an ER visit such as:

• ambulance transport
• doctor’s visits
• inpatient treatment or partial hospitalizations for mental health disorders

Medicare Part B is responsible for covering these services.

What does Part B cover?

If a person has to stay at an ER overnight or for longer than 24 hours, hospital personnel should give them a Medicare Outpatient Observation Notice (MOON) .

Receiving a MOON form usually means that Part B, not Part A, will cover the initial ER visit.

Medicare Part B usually covers most aspects of an individual’s visit to an ER, as long the doctor does not admit them to the hospital for reasons related to the visit.

If the doctor discharges a person from the ER to their home, they may be responsible for some or all of the following costs under Part B:

• a copayment for the emergency department visit
• a copayment for hospital services provided, such as imaging studies, medications, or lab work
• 20% of the Medicare-approved amount for a doctor’s services
• the deductible, which applies for doctor’s services

One exception to the ER coverage rules applies when a person returns to a hospital in need of inpatient care within 3 days of their initial visit to the ER.

If the hospital admits the person with the same medical condition, they do not have to pay their Part B copayment twice.

Medicare Part B also pays for ambulance and helicopter transportation when a person urgently requires moving to another location and is unable to get there without medical assistance.

The out-of-pocket expenses for emergency transportation to an ER include the 20% coinsurance. The Part B deductible applies to this amount.

If an ambulance company believes Medicare may not cover their service, they must provide an Advance Beneficiary Notice of Noncoverage .

This often applies if a person requests ambulance transport to an emergency room when their medical situation is not an emergency.

Does Medicare Advantage cover ER visits?

Medicare require that a Medicare Advantage plan covers the same aspects of care as Original Medicare. This means that Medicare Advantage also covers ER visits.

Medicare Advantage, or Medicare Part C, is a bundled plan that a private insurance company administers.

Medicare Advantage includes benefits from Parts A, B, and sometimes D, which covers prescription drug coverage. It may also offer coverage for services, such as vision, dental, and hearing care.

However, some types of Medicare Advantage plan require that a person chooses an in-network treatment provider when receiving emergency medical attention.

A person should review their Medicare Advantage plan so that they know their nearest in-network ER before they require emergency treatment.

Otherwise, they may have to pay more for seeking care at an out-of-network facility.

Find out more about the benefits of Medicare Advantage.

Does Medigap pay for ER visits?

Medicare Supplement Insurance, or Medigap, is a supplemental insurance plan that a person who has Original Medicare may purchase to cover some out-of-pocket expenses, including those for Medicare Part B.

Medicare requires that Medigap plans offer the same benefits regardless of the insurance provider. A person can choose from one of several plans depending upon their healthcare needs and monthly budget.

Most Medigap plans pay for all or part of Part B’s coinsurances or copayments. This may help a person reduce the costs of an ER visit.

Read more about Medigap.

Medicare Part B is the Medicare portion that usually pays for ER services.

An exception applies if a doctor admits a person to the hospital, at which point Medicare Part A would pay for the visit. ER staff should inform a person whether they are an inpatient or outpatient at an emergency room.

Even if a person stays overnight for testing or observation at an emergency room, this does not necessarily mean they are an inpatient.

Last medically reviewed on May 14, 2020

• Emergency Medicine
• Health Insurance / Medical Insurance
• Medicare / Medicaid / SCHIP

How we reviewed this article:

• Advance beneficiary notice of noncoverage. (n.d.). https://www.medicare.gov/claims-appeals/your-medicare-rights/advance-beneficiary-notice-of-noncoverage
• Ambulance services. (n.d.). https://www.medicare.gov/coverage/ambulance-services
• Emergency department visits. (2017) https://www.cdc.gov/nchs/fastats/emergency-department.htm
• Emergency department services. (n.d.). https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b
• Fact sheet: Two midnight rule. (2015). https://www.cms.gov/newsroom/fact-sheets/fact-sheet-two-midnight-rule-0
• Medicare outpatient observation notice (MOON). (2020). https://www.cms.gov/Medicare/Medicare-General-Information/BNI/MOON
• What Part A covers. (n.d.). https://www.medicare.gov/what-medicare-covers/what-part-a-covers
• What's not covered by Part A and Part B? (n.d.). https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b
• What Part B covers. (n.d.). https://www.medicare.gov/what-medicare-covers/what-part-b-covers

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Does Medicare Cover Emergency Room Visits? 

Yes, Medicare covers emergency room visits in a wide variety of circumstances. Medicare Part B covers emergency room visits for sudden illness, injuries, or other conditions that require immediate attention. If you’re admitted to the hospital from the emergency room, Medicare Part A covers your inpatient treatment and inpatient hospital stay .

Patients with Medicare Advantage may see additional benefits for ER visits, such as a set or waived copay .

Learn more about your expected share of costs for emergency room coverage as a Medicare beneficiary, and your alternative options if you need non-emergency care.

Table of Contents

Emergency room care a priority for older adults .

Emergency room visits are a medical necessity for many older adults. Falls are a  leading cause of emergency room visits  for older adults with Medicare in 2023, and other common reasons for emergency care include chest pain or stroke, car accidents, and heat-induced exhaustion. Medicare Part A and Part B, also called Original Medicare , works together to cover different aspects of emergency services for beneficiaries, ensuring access to necessary care.

When to Go to the Emergency Room 

Emergency healthcare professionals use a tiered triage system to treat incoming patients by the severity of their condition. The above table illustrates a range of examples of when to go to the ER, from low-priority injuries or ailments (level 5) to life-threatening conditions (level 1). 

The following urgent symptoms always warrant a trip to the ER:

• Chest pain or pressure
• Difficulty breathing or shortness of breath
• Severe abdominal pain or cramping
• Head injury or severe headache
• Seizures or loss of consciousness
• Severe burns or cuts
• Broken bones or dislocated joints
• Severe allergic reactions
• Signs of a stroke or heart attack

How Medicare Covers Emergency Room Visits 

Emergency services may be covered by Medicare Part A or Part B, depending on the nature of the visit. While broad coverage in an emergency is guaranteed, it is important to understand which part covers which services, since you must meet your respective Part A and Part B deductibles before Medicare begins sharing costs for emergency services.

Overall Eligibility Criteria

For Medicare to pay for emergency room visits, beneficiaries must be experiencing a medical emergency that requires immediate attention. Coverage is not guaranteed for beneficiaries who visit the emergency room in a non-emergency situation. The emergency room facility must also accept Medicare.

How Medicare Part A Covers Emergency Services 

Medicare Part A covers the following inpatient emergency services:

• Inpatient hospital care:  Inpatient hospital care covered under Part A includes the cost of your stay in the hospital and any treatments required therein. Coverage includes general nursing, drugs used during your stay and specific to your reason for admission, and semi-private room accommodations. Part A benefits do not cover private rooms or private nursing services.
• Long-term hospital care:  Once you pay your Part A deductible, Medicare covers a hospital stay of up to 60 days at no charge. After 60 days, you must pay  coinsurance , or a portion of the cost, to continue your inpatient treatment.

Part A Coverage Criteria

Patients must be admitted to the same hospital where they visit the ER for at least two consecutive midnights to get coverage through Part A. So long as the patient is not admitted to the hospital, Part B pays for their care as an outpatient even if they spend the night in the emergency room.

How Medicare Part B Covers Emergency Services 

Medicare Part B covers the following emergency  outpatient services :

• Doctor care: Part B pays 80% of the costs of ambulatory care provided by a doctor in the ER, as long as you are not admitted to the hospital.
• Outpatient hospital care: Part B covers care provided to you in a hospital setting as an outpatient. Examples include overnight observation assessments,  x-rays , and lab tests, and excludes medications you can administer yourself without the aid of a doctor.
• Emergency transportation: Emergencyambulance transportation to the nearest medical facility is covered under Part B, as long as the patient demonstrates that riding in any other vehicle would endanger their health, they are unconscious, or they require medical intervention during the ride. It may also be covered if you have a written order from your doctor stating the ambulance is medically necessary. 

Part B Coverage Criteria

Medicare Part B covers  outpatient services  and routine medical care, including ambulatory care in the ER that does not require hospitalization. However, once you are admitted to the hospital, Part A covers your care.

How Medigap Covers ER Visits 

Medigap offers supplemental coverage to help beneficiaries pay their Part A and Part B deductibles, copays, and coinsurance costs. You must have Original Medicare in place to purchase a  Medigap plan  from a private insurer.

Medigap may help cover your Part B deductible and the remaining 20% of ER costs that are your financial responsibility after Original Medicare pays for its share of costs.

How Medicare Advantage Covers ER Visits 

Medicare Advantage is also known as Part C, and it offers the same coverage as Part A and Part B, but often with extras such as  vision ,  dental , and  hearing  services. These plans are offered by private insurance companies approved by Medicare, so plan benefits, costs, and availability vary.

Medicare Advantage Plans  are required to offer at least the same levels of coverage for emergency room visits as Original Medicare. However, the expanded benefits of many Part C plans may extend to ER services. For example, some MA Plans allow beneficiaries to waive their copay for an ER visit if they are admitted to the hospital within 24 hours, cutting down on costs due.  

Medicare Advantage beneficiaries should review their policy to see how their plan covers emergency room visits, or speak with a trusted agent for more details.

How Much Does an ER Visit Cost Without Medicare? 

The  average ER visit  cost $1,150 in 2020. Specifically, uninsured people paid an average of $2,188 for one or more visits to the ER that same year, with older people aged 45-64 paying even more at $2,243.

In contrast, Medicare beneficiaries pay either 20% of the approved care cost if they visit the emergency room once the Part B deductible is met, or the corresponding Part A copay if they are hospitalized once that deductible is met. This is often less expensive than paying for care out of pocket.

Alternatives For Medicare-Covered Care If You Do Not Have an Emergency 

Medicare does not cover emergency room services if you are not experiencing a medical emergency. However, if you require non-critical but urgent medical attention, you may find the help you need through one of the following Medicare-covered ER alternatives:

• Urgent care clinics: Most  urgent care clinics  accept Medicare for the treatment of non-life-threatening but time-sensitive injuries or illnesses. Once you have met your Part B deductible, you are responsible for 20% of the cost of the urgent care visit. If you have not yet met the deductible, you may be responsible for paying out-of-pocket for this visit.
• Telehealth services : Medicare covers 80% of telehealth services under Part B as routine outpatient medical care. This is useful if you do not need hands-on treatment. For example, if you have a mental health emergency or need a healthcare provider to walk you through next steps, telehealth care can help. Like other Part B benefits, you must meet your deductible before Medicare pays their portion of this cost.
• Routine medical doctor’s appointment: Medicare also doctor appointments under Part B. If you can see your physician to address your emergency, this could be an ER alternative for care. You must meet your deductible in order for Medicare to pay 80% of this cost.
• Retail clinics: Medicare covers retail and other walk-in clinics under Part B, such as MinuteClinics inside CVS stores, RediClinics at Rite Aid, and Walmart Health Clinics. This could serve as an alternative for care if you have questions or concerns about medications. You must meet your deductible for Medicare to pay 80% of this cost.

Putting It All Together 

The cost of accessing emergency medical services should never discourage someone from seeking help. This advice applies to everyone, regardless of their age or health status, but is especially relevant to Medicare beneficiaries who may require emergency room visits more frequently than the average person. 

Medicare covers emergency services through Part B benefits, which include outpatient medical care. Beneficiaries who meet their Part B deductible owe 20% of ER costs, which includes treatment during their visit to the ER and ambulance transportation . Medicare also covers hospitalizations ordered by ER doctors and related expenses through Part A, should a patient require longer-term inpatient care.

You’re just a few steps away from seeing your Medicare Advantage plan options.

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What Happens if I Go to the E.R. Without Insurance?

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An emergency room (ER) visit can cost up to $2,700 if you don’t have insurance. With insurance, the average cost decreases to $1,150.

Keep reading to learn more about what goes into how much an emergency room visit is without insurance. We also share tips on ways to lower your ER bill and your options for financial aid if you need it.

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How Much Does It Cost To Visit an Emergency Room Without Insurance?

How does an emergency room work, does health insurance cover emergency room visits, how do i save at the er, how to get health insurance that will cover an emergency room visit.

The average cost of visiting the emergency room without health insurance will vary depending on the facility and services used. For instance, UnitedHealthcare places the average cost at $2,700 for ER visits. [1] Consider that a visit to the emergency room for a minor injury such as a sprained ankle or a cut that requires stitches can cost several hundred dollars. [2] On the other hand, a visit for a heart attack can cost over $28,000. [3] Below is a table showing breakdowns of costs for common emergency room conditions and services: [2]

The average cost will also vary by state since the cost of services, treatment and the cost of living will depend on where you live. 

In addition to the cost of the services provided, patients will be responsible for facility fees, physician fees and other charges. A facility fee covers the cost of using the emergency room, while a physician fee is linked to the medical care provided by the doctor or other medical professional.

What if I Can’t Afford To Pay My ER Bill?

If a patient cannot afford to pay the full cost of their emergency room visit, they may be able to negotiate a payment plan or apply for financial assistance. Hospitals are bound by law to offer financial assistance programs that provide discounted or free medical care to patients who meet certain income criteria. [4] Any unpaid medical bills will be sent to collections. Your credit may be dinged and in severe cases, you may have to declare bankruptcy.

It is also important to note that there are laws in place to protect patients from excessive medical bills.

For example, hospitals are required to provide an estimate of the cost of services before providing them. [5] This allows patients to save money by refusing services that they believe to be nonessential.

Keep in mind that emergency rooms are federally mandated under the Emergency Medical Treatment and Labor Act (EMTALA) to provide emergency medical services to anyone regardless of their insurance status . [6]

When a patient arrives at the emergency room, the first step is usually triage, which is the process of prioritizing patients based on the severity of their condition. Patients with life-threatening conditions such as severe bleeding or suicidal feelings are given the highest priority.

According to Mira, emergency rooms will file patients into one of five acuity categories depending on their severity. [2]

Those with emergency medical needs will be taken immediately to an exam room where they are evaluated by a physician or nurse practitioner. If the patient’s needs are non-urgent, they may be sent to the waiting room until another exam room opens up. This ensures there are spaces for new patients who require immediate care. If the patient's symptoms are dire, like suffering from head trauma, they’ll be taken to a specialized area like an operating room.

Based on the medical evaluation and tests completed, the medical staff will determine and explain the appropriate course of treatment. This may include medication, procedures such as stitching a wound or draining an abscess or surgery.

How Does ER Billing Work?

When a patient visits the emergency room, they can receive services from multiple providers, including the hospital, the physician and any specialists involved in their care. You can break down the various costs from each by triage fees, facility fees, professional fees and supplies. The triage fee can be anywhere between $200 to $1,000. [2]

The second bill that the patient will receive is the facility fee in order to help cover the costs of running the physical building. The average facility fee in 2021 was $713. [7]

The professional fee is next, with the average cost in 2021 being $321. [7] Note that each professional gives a quote for their services and may include radiologists, pathologists and more. [8]

You will also be charged for any supplies used to treat you including syringes, laryngoscopes and laparoscopes, as well as durable medical equipment (DME) like braces or splints.

If you were transported via a ground ambulance service, you can expect to pay $1,277, on average, for that service. [9]

Your health insurance policy covers ER visits as part of its standard benefits up to a certain amount. Also, insurance companies cannot charge you more for getting emergency services from an out-of-network provider or facility. [10] You can see how much your out-of-pocket cost will be on your health insurance card. The average emergency room cost with insurance in 2020 was $1,150. [11]

However, the amount of coverage may vary depending on the type of plan such as whether you have an HMO or PPO policy.

Your insurance company will have a negotiated rate with a healthcare provider or facility for how much your carrier will spend on a specific type of care.

Any costs that exceed this negotiated rate will usually need to be paid by you out of pocket.

ER visits can be expensive but there are several ways to save money and reduce the cost of an emergency room visit. Here are some tips to lessen the blow to your pocketbook:

• Know your insurance coverage: This includes your copays, coinsurance and deductibles . Once you have this information, you can make an informed decision as to when it’s best to spend your money.
• Consider an urgent care facility or telemedicine: While ERs are staffed 24/7, not all medical situations require a visit to the emergency room. [12] In cases of minor illnesses or injuries, patients may be able to receive cheaper treatment at an urgent care clinic, their primary care physician's office or via virtual appointment
• Use community health clinics: These clinics can provide treatment for minor injuries and illnesses and can help avoid the higher cost of an ER visit.
• Negotiate your bill: Many hospitals have financial assistance programs that can provide discounted or free medical care to patients who meet certain income criteria.
• Regularly receive preventive care: Be sure to include regular check-ups, screenings and vaccinations that can help prevent serious health conditions and avoid costly ER visits.
• Be prepared: Bring your insurance card, a list of current medications and a description of your medical history. Doing so may cut down on any labs or tests they may otherwise run, saving you some money.

If you want coverage for an ER visit but don’t have it, there are several ways to purchase health insurance :

• Individual or group health insurance plan: You can enroll in a plan through your employer, through the health insurance marketplace or directly from an insurance company. Most states hold open enrollment for health insurance from November 1 through January 15. Once you have a health insurance plan, you will be covered for emergency medical conditions, including those requiring an ER visit.
• Medicare: This is typically meant for the elderly. Medicare open enrollment begins October 15th and goes through December 7th every year with coverage beginning January 1st.
• Medicaid: This coverage provides health insurance for people who meet certain income requirements. Medicaid covers conditions requiring an ER visit.
• Children's Health Insurance Program (CHIP): Children in families who earn too much to qualify for Medicaid but cannot afford private health insurance may qualify for coverage. CHIP covers emergency medical conditions.
• Short-term health insurance: Coverage periods are typically less than 12 months. [13] These plans can be more affordable than traditional health insurance plans, but they may have limited coverage for pre-existing conditions and may not cover all medical services, including some emergency medical conditions.
• Continuation of Health Coverage COBRA: This allows you to continue your employer-sponsored health insurance plan for a limited time if you recently lost your job. COBRA coverage can be expensive but it can provide coverage for emergency medical conditions, including those requiring an ER visit.

Does health insurance always cover emergency room visits?

Your health insurance will cover emergency room visits regardless of where you are. However, some health plans may specify that you go to one of their in-network facilities if it is feasible to do so.

Does Medicare cover emergency room visits?

Medicare Part B will pay for emergency room visits. You will have a copay and when you meet your Part B deductible, you will pay an additional 20% for your doctor’s services. [14]

What’s the difference between emergency rooms and urgent care?

Emergency rooms treat serious and life-threatening conditions, while urgent care centers treat less severe issues and often carry shorter wait times and lower costs.

What happens if you go to the ER without insurance?

Emergency rooms are required to give you medical care if it is needed even if you don't have insurance. If you require immediate medical care, call 9-1-1 and they will take you to the nearest emergency room.

What is the average cost of an emergency room visit with insurance?

The average cost of an emergency room visit in 2020 was $1,150. The cost will vary depending on the type of plan, such as whether you have an HMO or PPO .

• UnitedHealthcare. “ What Are My Care Options and Their Costs? ” Accessed March 29, 2023. 
• Mira. “ Emergency Room Visit Cost Without Insurance in 2023 .” Accessed March 29, 2023.
• Sidecar Health. “ Cost of Heart Attack in California .” Accessed March 29, 2023.
• Internal Revenue Service. “ Financial Assistance Policy and Emergency Medical Care Policy – Section 501(R)(4) .” Accessed March 29, 2023.
• A+ Urgent Care. “ No Surprises Act. ” March 29, 2023.
• American College of Emergency Physicians. “ Understanding EMTALA .” Accessed March 29, 2023.
• Peterson-Kaiser Family Foundation. “ How Do Facility Fees Contribute to Rising Emergency Department Costs? ” Accessed March 29, 2023.
• Advance ER. “ Understanding ER Billing .” Accessed March 29, 2023.
• White Paper. “ Ground Ambulance Services in The United States ,” Page 2. Accessed March 29, 2023.
• HealthCare.gov. “ Using Your Health Insurance Coverage. ” Accessed March 29, 2023.
• Consumer Health Ratings. “ How Much Does an ER Visit Cost? ” Accessed March 29, 2023.
• Frontline ER. “ Are Emergency Rooms Open on Weekends? ” Accessed March 29, 2023.
• Kaiser Family Foundation. “ Understanding Short-Term Limited Duration Health Insurance .” Accessed March 29, 2023.
• Medicare.gov. “ Emergency Department Services .” Accessed March 29, 2023.
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• How Much Is An Er Visit Without Insurance

Derek has written 100+ articles on property & casualty, health and life insurance topics as an insurance expert for SmartFinancial. Within his decade-long career writing about finances, entertainment, religion and philosophy, Derek spent three years writing financial articles for credit unions throughout the U.S. He prides himself on his ability to translate complex topics into actionable tips for everyday people.

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Visiting the emergency room (ER) can be a stressful and overwhelming experience, especially when you don’t have health insurance. Many people are unsure of what to expect when it comes to the cost of an ER visit without insurance. In this article, we will provide an in-depth look at the factors that influence the cost of an uninsured ER visit, the average expenses you can expect to incur, and some tips on how to navigate the financial aspects of an emergency medical situation. Whether you’re facing an unexpected medical emergency or simply want to be prepared for the future, this article will give you the information you need to understand the costs associated with an ER visit without insurance.

Table of Contents

Understanding the cost of an er visit without insurance, factors that affect er visit costs for uninsured patients, tips for managing emergency room expenses without insurance, negotiating your er bill and finding financial assistance programs, the conclusion.

When it comes to seeking medical attention in an emergency room, one thing is certain: it can be costly, especially if you don’t have insurance. The price for treatment can vary greatly depending on the severity of your condition, the tests and procedures needed, and the hospital you visit. On average, an ER visit can range from $150 to $3,000 or more for basic care, and can easily exceed $20,000 for more serious conditions that require hospitalization or surgery.

It’s important to understand that ER charges are often higher than those for the same services provided in a doctor’s office or urgent care center , due to the higher overhead costs associated with operating an emergency department. Additionally, many hospitals charge a facility fee, which covers the cost of maintaining the emergency room, medical equipment, and staff. This fee can range from a few hundred dollars to several thousand dollars, and is separate from the cost of medical treatment.

Here is a breakdown of some common ER services and their average costs without insurance:

• Basic ER visit : $150 – $3,000
• Lab tests : $100 – $3,000
• X-rays : $150 – $1,000
• CT scans : $500 – $3,000
• MRIs : $1,000 – $5,000
• Sutures : $150 – $2,500
• Emergency surgery : $5,000 – $50,000+

It’s worth noting that these prices are just estimates and can vary widely depending on the hospital and its location. In some cases, hospitals may offer discounts or payment plans for uninsured patients. It’s always a good idea to ask about these options and to inquire about the costs of services before receiving treatment, if possible. Remember, the best way to avoid high ER costs is to have health insurance coverage, but if that’s not an option, understanding the potential costs can help you make informed decisions about your care.

When it comes to visiting the ER without insurance, there are several factors that can impact the overall cost. Firstly, the severity of the condition being treated plays a significant role in the final bill. For example, a simple sprain or minor cut may only result in a few hundred dollars in charges, while a more serious condition such as a heart attack or stroke can easily rack up tens of thousands of dollars in medical expenses.

Another important factor is the location of the hospital. Hospitals in urban areas tend to charge more for emergency room visits than those in rural areas. Additionally, some hospitals may have higher costs due to their reputation or the level of specialized care they offer.

Here are some other factors that can affect the cost of an ER visit for uninsured patients:

• The time of day or night the visit occurs
• The number of tests and procedures performed
• The amount of medication administered
• Any additional services required, such as ambulance transportation or overnight observation

It’s important to note that these are just estimates and the actual cost can vary greatly depending on individual circumstances. Uninsured patients should always inquire about financial assistance options and potential payment plans to help manage the cost of an ER visit.

Visiting the emergency room without insurance can often result in high medical bills that can be difficult to manage. However, there are several ways you can reduce the costs and avoid being overwhelmed by the expenses.

Research and Compare Prices

• Not all emergency rooms have the same pricing. Before deciding where to go, research the prices of different emergency rooms in your area. Some hospitals provide pricing information on their website, or you can call and ask for an estimate.
• Consider urgent care centers for non -life-threatening medical issues . The cost of an urgent care visit is usually lower than the emergency room.

Negotiate Payment Plans

• Ask the hospital if they offer a payment plan. Many hospitals are willing to work with patients to create a payment plan that fits their budget.
• Some hospitals offer financial assistance programs for patients without insurance. These programs may reduce the total cost of your bill or provide a discount.

Remember, the best way to manage emergency room expenses is to be prepared. Make sure to have some money saved for unexpected medical costs and always ask questions about the costs before receiving treatment.

If you’ve ever found yourself in the emergency room without insurance, you know that the cost can be staggering. On average, an ER visit can range anywhere from $150 to $3,000 or more , depending on the severity of your condition and the tests and treatments required. However, there are ways to negotiate your bill and find financial assistance programs to help alleviate the burden.

Firstly, it’s important to know that hospitals are often willing to work with patients on their bills. Consider asking for an itemized bill and review it carefully for any errors or charges for services you didn’t receive. If you find any discrepancies, don’t hesitate to bring them up with the billing department. Additionally, you can negotiate a payment plan or ask for a discount based on your financial situation. Many hospitals offer financial assistance programs for uninsured patients, so be sure to inquire about what options are available to you.

Here are some steps you can take to negotiate your ER bill:

• Request an itemized bill and review it thoroughly
• Contact the billing department to discuss errors or discrepancies
• Ask about payment plans or discounts based on your financial situation
• Inquire about financial assistance programs offered by the hospital

Furthermore, there are various financial assistance programs available at the state and federal level that can help cover the cost of your ER visit. For example, Medicaid and the Children’s Health Insurance Program (CHIP) are two programs that provide assistance to eligible individuals. Additionally, some hospitals have their own charity care programs that can help cover the costs for uninsured patients who meet certain income guidelines. It’s worth researching and applying for these programs to help ease the financial burden of your ER visit.

Q: How much does an ER visit cost without insurance? A: The cost of an ER visit without insurance can vary widely depending on the location and the services received. On average, the cost can range from $150 to $3,000 or more.

Q: What factors influence the cost of an ER visit without insurance? A: The cost of an ER visit without insurance is influenced by factors such as the severity of the injury or illness, the procedures and tests performed, the medications administered, and the hospital’s pricing.

Q: Can I negotiate the cost of an ER visit without insurance? A: Yes, it is possible to negotiate the cost of an ER visit without insurance. Many hospitals have financial assistance programs or may be willing to negotiate a payment plan.

Q: What should I do if I can’t afford the cost of an ER visit without insurance? A: If you cannot afford the cost of an ER visit without insurance, it is important to communicate with the hospital’s billing department. They may be able to offer financial assistance, payment plans, or discounts.

Q: Are there alternative options for individuals without insurance who need medical care? A: Yes, there are alternative options for individuals without insurance who need medical care, such as urgent care centers, community health clinics, and telemedicine services. These options may offer more affordable care for non-life-threatening conditions.

Q: Are there any resources available to help individuals estimate the cost of an ER visit without insurance? A: Yes, there are resources available to help individuals estimate the cost of an ER visit without insurance, such as healthcare cost transparency websites and hospital cost estimation tools. These resources can provide a general idea of the potential costs to expect.

In conclusion, the cost of an emergency room visit without insurance can vary greatly depending on the severity of the situation and the specific services required. It is important to be aware of the potential financial burden of an ER visit and to explore other options for care when possible. While the cost may be daunting, it is essential to seek medical attention in emergency situations and to consider options for obtaining health insurance to help mitigate the financial impact of unexpected medical expenses. We hope that this information has provided clarity on the potential costs and implications of seeking emergency care without insurance.

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Navigating the health care system in the United States can often feel like being lost in a maze. What kind of doctor should I see? Who takes my insurance? What even is a co-pay, anyway?

For that reason, Chris Hamby, an investigative reporter, has devoted much of his five-year career at The New York Times to guiding readers through such dizzying questions. His latest article, which was published online this month , explored the complex subject of insurance bills.

Last year, Mr. Hamby began investigating MultiPlan, a data firm that works with several major health insurance companies, including UnitedHealthcare, Cigna and Aetna. After a patient sees an out-of-network medical provider, the insurer often uses MultiPlan to recommend how much to reimburse the provider.

Mr. Hamby’s investigation revealed that MultiPlan and the insurers are incentivized to reduce payments to providers; in doing so, they score larger fees, which are paid by the patient’s employer. Many patients are forced to foot the rest of the bill. (MultiPlan said in a statement to The Times that it uses “well-recognized and widely accepted solutions” to promote “affordability, efficiency and fairness” by recommending a “reimbursement that is fair and that providers are willing to accept in lieu of billing plan members for the balance.”)

In an interview, Mr. Hamby shared his experience poring over more than 50,000 pages of documents and interviewing more than 100 people. This conversation has been edited.

Where did your investigation begin?

We were broadly looking at issues in health insurance last year. MultiPlan kept coming up in my conversations with physician groups, doctors and patients. At first, it was unclear what exactly MultiPlan did. There were some lawsuits regarding its work with UnitedHealthcare, but it was difficult to understand the company’s role in the industry. We eventually accumulated more information about MultiPlan’s relationship with big insurance companies.

What were doctors and other providers saying?

Mostly that they’d seen their reimbursements dramatically cut in recent years and that it was becoming difficult for them to sustain their practices. They said they previously had more success negotiating and obtaining higher payments.

Of your findings, perhaps the most surprising is that MultiPlan receives a cut of the money it saves employers.

Yes, but I wouldn’t call it a cut. It’s very complicated. MultiPlan charges a fee based on the savings that they obtain for employers. But in some cases, that savings is passed onto a patient as a bill. Both insurers and MultiPlan have financial incentives to keep payments low because they receive more money, in many cases.

But it wasn’t always that way, correct?

Right. MultiPlan was founded in 1980, and it was a fairly traditional out-of-network cost containment company. Doctors and hospitals agreed to modest discounts with MultiPlan, and agreed not to try and collect more money from patients. It was a balancing act.

But that balancing act changed over time. MultiPlan’s founder sold the company to the Carlyle Group, a big private equity firm, in 2006. It moved away from negotiations and toward automated pricing. They bought one company in 2010, and another, key company in 2011, and in doing so, acquired these algorithm-driven tools that became the backbone of MultiPlan’s business.

You read more than 50,000 pages of documents for your investigation. How does one begin to sift through that much information?

I love a good trove of documents. There wasn’t some big leak. It was more about piecing together information from many different sources — legal filings, documents that providers and patients shared with me, their communications with MultiPlan and insurers. We asked federal judges to unseal a few documents that had previously been confidential, including emails between Cigna executives, paperwork describing how some of MultiPlan’s tools worked and data on thousands of medical claims.

What was the greatest challenge in your reporting?

Finding patients and providers who were willing to speak on the record about their experiences, because this is a really sensitive subject. A number of providers were concerned that if they spoke on the record, insurance companies would retaliate. For many of the patients I spoke with, it also meant putting their personal medical history out there for the public to read.

What about health care and the pharmaceutical industry drew your interest as a reporter?

For many Americans, health care is an almost universally frustrating or confusing experience. It’s one that has direct effects on people’s health, their pocketbooks or both. I really like learning about the stuff that impacts people’s health. I try to make that information accessible to millions of people who are affected by it but who might not have a lot of time to understand it.

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How Much Does an Emergency Vet Cost for Dogs? 2024 Price Update

Image Credit: RossHelen, Shutterstock

Last Updated on April 12, 2024 by Dogster Team

VET APPROVED

REVIEWED & FACT-CHECKED BY

Dr. Tabitha Henson

DVM (Veterinarian)

The information is current and up-to-date in accordance with the latest veterinarian research.

Your dog may become sick or injured when your vet clinic is closed and when this happens, you will have to rush your dog to an emergency vet clinic.

Beyond the worry and fear of this kind of visit, sometimes the price is a factor. How much a visit to an emergency vet clinic costs depends on several factors. But as a general overview, the average cost of an emergency vet could be anywhere from $250 to as much as $8,000. Here, we get into what these are and provide you with a range of possible prices that you can expect to pay under those circumstances.

• The Importance of Your Dog’s Health

We all want our pets to be in good health for their entire lives, but accidents and health conditions can happen unexpectedly. Several conditions can lead you to bring your dog to an emergency vet clinic, including:

• Injuries and trauma (possible broken bones, deep gashes, burns, etc.)
• Gastroenteritis (diarrhea, vomiting)
• Neurological disorders (seizures)
• Weakness and collapse
• Difficulties breathing
• The ingestion of toxins
• Extreme lethargy
• Significant bleeding
• Straining to urinate or blood in urine

Of course, this list is not exhaustive, and there are times when you will need to figure out when it’s a real emergency . If you’re unsure if your dog requires a vet’s help, call ahead to the emergency clinic, and the staff can help you decide if it’s necessary to bring your dog in. You also have the advantage of giving them advance notice that you’re coming.

• How Much Does an Emergency Vet Visit Cost?

How much a visit to an emergency vet will cost depends on numerous details, including the time, day, location, size of your dog, the clinic itself, and what condition or injury your dog has.

The vet will typically start with a thorough physical exam of your dog to determine if there are any other underlying issues beyond what you brought them in for.

This could be followed by the vet recommending treatments and further diagnostic tests, which might include running bloodwork or a urinalysis, X-rays, ultrasounds, surgery, etc. In most cases, your dog might only need medication, but in some circumstances, a stay at the clinic and extensive workup might be in order.

The average cost of an emergency vet could be anywhere from $250 to as much as $8,000.

The following chart should help break down these costs.

Remember that these costs are just general estimates and averages. With so many varying factors, it’s difficult to precisely pinpoint what you’ll end up paying.

However, even the estimated prices are impressive. If you have a desire to save money during an emergency for your dog, it doesn’t make you a bad owner. It shows that you want to anticipate such situations and save your nerves.

Being a pet parent is not only about fun games and cuddling with your dog. It is also about being responsible and making decisions about what’s best for your pooch and you.

Therefore, the sooner you start thinking about pet alternative insurance and how to act in emergencies, the less stressful such a case will be for you.

• Additional Costs to Anticipate

Beyond the visit, treatment, and any diagnostic tests, there are a few additional expenses that you might need to pay.

Any medications that your vet prescribes for your dog—oral medications or even topical treatments—will need to be paid for separately.

There’s the possibility of equipment, particularly after surgery, such as e-collars and vests, so your pup doesn’t chew and lick the wound.

You’ll potentially need to bring your dog back to the clinic for follow-up appointments, particularly if your dog was physically injured. There’s also the chance of you needing other specialty items, depending on your dog’s condition, such as prescription dog food.

• How Can I Afford an Emergency?

There are a few steps that you can take to help you afford an emergency situation.

• Talk to the Vet

First of all, let the vet know about your finances. This way, they can find less expensive alternatives that where possible, won’t compromise your dog’s health. This can also include asking for generic rather than brand-name prescriptions and filling them at your own pharmacy.

• Specialized Credit Cards

There are specialized credit cards that you can consider. It enables you to pay for your dog’s and your own medical needs. You’ll just need to make sure the emergency clinic and your regular vet will accept the card.

• Plan a Budget

Consider setting up a savings account meant for any dog medical emergencies. You can create a new account and make a point of adding money every week or month.

If you put about $100 in the account every month when your dog is a puppy, by the time, they’re 2 years old, you might have saved up around $2,000. Only use this money for actual emergencies, rather than routine visits. This way, you’re saving money that could end up saving your dog’s life.

• Virtual Vet

If your dog isn’t exhibiting emergency symptoms but you feel as though you can’t wait for an appointment in a few days, you can try speaking to a virtual veterinarian. This could be done by phone or through video.

For example, if you suspect that your dog has an ear infection, this isn’t exactly an emergency (at least not in the early stages), and a virtual vet can prescribe you the appropriate medication. This can help save you money.

There’s also pet insurance.

• Does Pet Insurance Cover Emergency Clinic Visits?

It depends on the insurance company. Some will cover emergencies but not if your dog has a pre-existing condition (although this is usually if your dog already had a health condition before you started coverage).

Typically, you pay anywhere from $10 to $100, but the average tends to be $30 to $50 every month. Some policies might cover a large chunk of the bills, up to 90% for many, and they all cover unexpected costs (except for those pre-existing conditions). In most cases, you will pay the bill yourself and then send the bill and vet records to the insurance company, and they will reimburse you, so you’ll still need to have the money initially for the vet bill.

Just be sure to read everything and figure out which company and which plan will work best for you and your dog. How much you pay every month will also depend on the size, age, breed, and sex of your dog.

• See Also:  What Are the Vet Costs for Dog Eye Infection & Eye Surgery?

• How Can You Avoid Emergency Vet Visits?

It will help if you take your dog to your regular vet for wellness checkups annually. If you’re consistent with these visits, your vet can sometimes catch an encroaching health condition before it becomes an emergency. Also, some insurance companies will cover part of these annual visits.

You should also always plan ahead for any potential emergencies. If you’re unable to make it home because of bad weather (blizzards, icy roads, etc.), ensure that a trusted neighbor, family member, or friend has a key to your place so they can take care of your dog in your absence. If you lose power, take your dog with you if you go to a hotel.

However, it can sometimes prove difficult to prevent all emergencies for pets. Accidents happen — you can’t keep an eye on your dog every minute, and they can be fast! Plus, health conditions can occur even in the healthiest of animals.

As long as you feed your dog high-quality food, ensure that they have constant access to clean and fresh water, and visit the vet once a year, you’re taking good care of your pup. You should also give them plenty of love, exercise, and playtime.

While paying a chunk of money every month might not necessarily fit into your budget, it’s probably worth it in the long run. This way, if something disastrous does happen to your pup, you won’t be forced to decide between treatment that you can’t afford and keeping your dog for a few more years.

So many aspects of these scenarios do depend on your dog’s situation, so spend the time looking at the best pet insurance companies and trying out the free quotes. It just might be worth it.

Related dog reads:

• What to Give a Dog for an Upset Stomach — 10 Great Options
• Braces for Dogs — Effectiveness and Costs
• My Dog’s Stomach Is Hard, What Should I Do?
• https://emergencyvetsusa.com/average-cost-of-emergency-vet-visits/

Featured Image Credit: RossHelen, Shutterstock

About the Author

Kathryn Copeland

Kathryn was a librarian in a previous lifetime and is currently a writer about all things pets. When she was a kid, she hoped to work in a zoo or with wildlife in some way, thanks to her love for animals. Unfortunately, she's not strong in the sciences, so she fills her days with researching and writing about all kinds of animals and spends time playing with her adorable but terribly naughty tabby cat, Bella. Kathryn is hoping to add to her family in the near future – maybe another cat or two and a dog.

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