cost of er visit with medicare

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How does Medicare cover emergency room costs?

Kimberly Lankford,

The type of Medicare you have determines how it pays for emergency department services.

Original Medicare covers emergency services under Medicare Part B at any U.S. hospital or medical facility that accepts Medicare. However, that care is subject to a deductible and 20 percent copayment. Supplemental insurance, such as a Medigap policy or a retiree plan from your former employer, may cover these out-of-pocket expenses.

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Medicare defines an emergency as an injury, sudden illness or an illness that gets much worse.

If you’re admitted to the same hospital for a related condition within three days, you won’t have to pay the copayment because the visit is considered part of your inpatient hospital stay, covered through Medicare Part A .

Medicare Part B also covers urgent care visits needed to treat a sudden illness or injury that isn’t a medical emergency. Urgent care visits are also subject to a deductible and 20 percent copayment.

How does Medicare Advantage cover emergency services?

Medicare Advantage plans typically have provider networks and generally charge higher copayments and deductibles or don’t cover out-of-network care at all. But the rules are different for emergency services.

In this case, Medicare Advantage plans must cover emergency care as an in-network service, even if the hospital or facility isn’t in the provider’s network. But copayments may be different from under original Medicare.

For example, you may need to pay as much as a $135 copayment for each emergency room visit, whether it’s at an in-network or out-of-network facility. You can compare emergency care copayments for each Medicare Advantage plan in your area using the Medicare Plan Finder . Click on the Plan Details blue button at the bottom of an Advantage plan’s description.

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A different definition of emergencies. For Advantage plans, the Centers for Medicare & Medicaid Services (CMS) considers an emergency medical condition one that, if not treated, could result in:

Serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or her unborn child.
Serious impairment to bodily functions.
Serious dysfunction of any bodily organ or part.

Your emergency medical condition status is not affected if a later medical review found no actual emergency, CMS says. The plan can’t require prior authorization for emergency services.

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With some MA plans, if you’re admitted to the hospital within 24 hours, you may not need to pay the copayment for the emergency room visit. Instead, it becomes part of your hospital stay.

How to find the details. Specifics vary by plan. See the plan summary on the website of each private plan or evidence of coverage. You can get to these documents through Medicare’s Plan Finder even if you’re not shopping for new coverage.

Log in if you have an account to see a summary of your current coverage. Or navigate through the Plan Finder by entering your zip code, choosing your coverage year, hitting the Continue button, clicking Medicare Advantage Plan (Part C) , tapping the Find Plans button and going though the questions. You don’t need to compare your drug costs, but you do want to get to the list of plans for your area and find your specific plan.

Click the Plan Details button, and on the next page the Plan website link. From there, your provider’s website will walk you through steps to learn information about your plan on its website. You’ll generally see a link to View plan summary or View plan documents within the plan information. Both documents are very detailed but often let you search within for “emergency” so you can find what’s relevant to your situation.

Urgent care also possible. Your Medicare Advantage plan may cover urgent care visits from out-of-network providers. These are nonemergency situations that require immediate medical attention when a network provider is not available, such as when you have a severe sore throat on a weekend and your doctor is off or if you’re traveling outside the plan’s service area.

You’ll have the same copayment as in-network urgent care, which could be around $50.

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How does Medicare cover emergency ambulance services?

Medicare Part B covers emergency ambulance services , but they’re subject to a deductible and 20 percent coinsurance. A supplemental policy should help cover those.

Part B will pay for ambulance transportation to a hospital or skilled nursing facility if traveling in any other vehicle could endanger your health. This applies to emergency transport in an airplane or helicopter if you need immediate and rapid transport that a ground service can’t provide.

Medicare Advantage, too, covers emergency ambulance services, but like its emergency room coverage, its copay rates can be high. You may have a $300 copay for each one-way trip. See the plan’s evidence of coverage for details.

Keep in mind

Medicare covers emergency room visits throughout the United States, but it typically doesn’t cover emergency care outside the U.S., except in limited circumstances .

Some Medigap policies cover foreign travel emergency care with a lifetime limit of $50,000. Some Medicare Advantage plans provide limited coverage for foreign travel emergencies. Specifics vary a lot by plan.

Another option is buying travel insurance , which may provide more coverage for emergency care and medical evacuation when traveling.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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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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Does Medicare Cover Emergency Room Visits?

by Christian Worstell
January 12, 2024
Reviewed by John Krahnert

Yes, emergency room visits are typically covered by Medicare .

Most outpatient emergency room services are covered by Medicare Part B, and inpatient hospital stays are covered by Medicare Part A.

Medicare Advantage plans (Part C) also cover ER visits . Many Medicare Advantage plans also offer benefits not found in Original Medicare.

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What Medicare Part A covers

Medicare Part A hospital insurance helps cover:

Inpatient care in a hospital
Skilled nursing facility care
Hospice care
Some home health care services

Medicare Part A is typically premium-free, as long as you or your spouse paid sufficient Medicare taxes while working.

If you go to the emergency room and are admitted as an inpatient , Medicare Part A helps cover some of the costs related to your hospital stay once your Part A deductible is met .

In 2024, the Medicare Part A deductible is $1,632 per benefit period .

What Medicare Part B covers

Medicare Part B is known as medical insurance and helps cover medically necessary services and preventive services, which can include:

Doctor’s office visits
Clinical research
Ambulance services
Durable medical equipment
Mental health services

Medicare Part B may also cover services you receive when you visit the emergency room as an outpatient.

Medicare Part B is optional, and if you enroll in Part B you must also enroll in Part A. Unlike Medicare Part A, which is premium-free for most people, you must pay a monthly premium for Medicare Part B.

The standard Part B premium in 2024 is $174.70 per month.

Emergency room copayments and coinsurance

Even if your emergency room visit is covered by Medicare, you are typically responsible for paying a portion of the costs, known as copayments or coinsurance.

Typically, you pay a Medicare emergency room copayment for the visit itself and a copayment for each hospital service.

How you are charged depends on several factors, including which part of Medicare covers your visit (Medicare Part A, Medicare Part B or both) and whether or not you have met your Part A and Part B deductibles.

In 2024, the Part A deductible is $1,632 per benefit period, and the Part B deductible is $240 per year.

Medicare Part A coinsurance

Generally, if you go to the emergency room and are admitted as an inpatient, Medicare Part A will cover a portion of the costs, and in 2024 you pay:

$0 coinsurance for each benefit period for days 1-60 spent in the hospital
$408 coinsurance for days 61-90 in each benefit period
$816 coinsurance per each “lifetime reserve day” beyond day 90 in each benefit period
All costs beyond lifetime reserve days

Remember, you must meet your Part A deductible before Medicare will pay its share for covered services.

Medicare Part B copayments

If you go to the emergency room and receive care from a doctor but are not admitted as an inpatient, Medicare Part B will typically cover a portion of your medical costs.

After your Part B deductible is met, you typically pay 20 percent of the Medicare-approved amount for most services, and Medicare pays the rest.

Medicare Advantage plans cover emergency room visits

Medicare Advantage (Medicare Part C) is an alternative to Original Medicare (Medicare Part A and Part B) that provides the same hospital and medical benefits as Original Medicare. This means that Medicare Advantage plans, like Original Medicare, will cover at least some of your emergency room costs.

Most Medicare Advantage plans may also cover benefits not included in Medicare Part A or Part B.

To learn more about Medicare Advantage plans that may be available in your area and to find out about the emergency room coverage they offer, speak with a licensed insurance agent today.

Explore Medicare Advantage plan benefits in your area

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at [email protected] .

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Does Medicare Cover Emergency Room Visits?

Written by: Rachael Zimlich, RN, BSN

Reviewed by: Selah Lee, Licensed Insurance Agent

Key Takeaways

Original Medicare Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). will cover at least a portion of your visit to the emergency room.

The part of Medicare that covers your visit will depend on if you are admitted or not.

If you are admitted to the hospital for at least two nights after an ER visit, Medicare Part A covers it.

If you are not admitted after an ER visit, Medicare Part B will cover it.

How Much Does Medicare Pay for an Emergency Room Visit?

Original Medicare will cover a portion of your visits to the emergency room, but whether or not you are admitted will determine if Part A or Part B coverage is used. In either case, you pay a portion of your cost for services, but Medicare pays the majority.

If you have a Medicare Advantage plan, your ER visit will be covered and the plan you choose will determine your out-of-pocket costs. You may also have to pay more for visiting doctors or facilities that are outside your plan’s network.

Does Medicare Part A or B Cover Emergency Room Visits?

Both Medicare Part A and B offer some coverage of emergency services depending on how long you need to stay in the hospital. If your ER visit leads to a hospital stay, Medicare Part A covers the costs, plus any services that were provided in the three days before your admission. If your visit is one where you are discharged from the emergency room or after just one night of observation, Medicare Part B will provide coverage.

Will Medicare Part A Cover Emergency Room Visits?

Medicare Part A only covers emergency room services when you are admitted by a doctor for at least two nights in the hospital. The “Two-Midnight” rule is important, because in some cases your doctor may just keep you one night for observation. These visits are considered outpatient care even though you spent the night in the hospital, and Medicare Part B will provide coverage.

Medicare Part B covers most emergency visits, especially if you are seen and sent home the same day, or spend one night for observation. Even if you are admitted, Part B will pay the portion of your bill that covers doctor’s services while Part A will pay inpatient hospital costs.

Have questions about your Medicare coverage?

Does Medicare Have a Copay for ER Visits?

Original Medicare does not have an established copay for emergency room visits. Instead, you will pay a share of the costs based on your Part A or Part B coverage, and which part of Medicare is applied to your visit.

If you are admitted for at least two nights after and ER visit and Part A is used, in 2024 you will pay:

A $1,632 deductible for each inpatient stay for each benefit period. Benefit periods reset every 60 days you spend outside of a hospital or skilled nursing facility.
If you were recently admitted and already paid this deductible for your benefit period, you will not have to pay it again for the same benefit period.
Coinsurance applies, also, but only after 60 days of hospitalization.

If you visit the emergency room and are sent home right away or are admitted for just one night of observation, Part B coverage applies. This will cost you:

Your annual deductible — $240 for 2024 — if you haven’t already met it for the year.
Twenty percent of the remainder of the Medicare-approved costs associated with the visit.

How Much of a Hospital Bill Does Medicare Pay?

When Medicare Part A is applied for emergency department visits that turn into an inpatient stay, your costs will be covered after you pay your deductible and coinsurance.

When Medicare Part B is used for an ER visit where you are not admitted or kept only one night for observation, Medicare pays for 80% of the approved cost after your deductible is met.

Can I Get Help Paying?

If you need help paying for your share of your emergency department bill — regardless of whether Medicare Part A or B was applied — you may be able to use additional coverage if you’ve signed up for a Medicare supplement plan . Medicare supplement plans can only be purchased if you have Original Medicare (Parts A and B). If you have a Medicare Advantage plan, you will need to leave that policy.

Costs of Medicare supplement plans vary based on which plan you choose. Medicare supplement plans can be used to cover costs such as deductibles, copayments and coinsurance that are not covered by Original Medicare.

How Many ER Visits Does Medicare Cover?

There is no limit to how many ER visits Medicare covers, but you may have to start a new benefit period if it’s been awhile since your last admission. If you are admitted to the hospital and it’s been more than 60 days since your last admission, you will have to start a new benefit period and pay your Part A deductible. If you were admitted within the last 60 days, you will not have to pay this deductible again since you are in the same benefit period.

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Who Covers Ambulance Transportation?

Regardless of whether you are admitted or not following an ER visit, Medicare Part B is used to pay for ambulance services. If you’ve already met your Part B deductible for the year, you will be responsible for 20% of the cost of these services.

What About Medications?

Medications that you are given while admitted in the hospital are covered under Part A. If you are given a prescription in the emergency room and sent home, you will have to pay for this medication unless you have Medicare Part D coverage (prescription drug plans). Costs for prescription coverage vary based on the Medicare Part D plan you choose.

What Medicare coverage is right for my specific situation?

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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.

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.

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

How much does an ER visit cost; happy couple drinking coffee

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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Will My Medicare Policy Cover a Visit to the ER?

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SmartFinancial Offers Unbiased, Fact-based Information. Our fact-checked articles are intended to educate insurance shoppers so they can make the right buying decisions. Learn More

Part B of Original Medicare covers emergency visits since emergency room (ER) visits are considered outpatient care. Should your visit turn into a hospital admittance, Part A of your plan would cover your costs. Keep in mind you will still need to pay copays, coinsurance and deductibles.

Keep reading to see how the different parts of Medicare work together to cover your healthcare costs.

How Much Does Medicare Cover for Emergency Room Visits?

What parts of medicare cover emergency room visits, does medicare have copays for hospital visits, how much is an emergency room visit without medicare.

Medicare covers ER visits after you've met your deductible, minus any copays or coinsurance costs. If you are admitted to the hospital for an inpatient stay following an ER visit, additional costs might apply.

Several parts of Medicare can play some role in covering your emergency room visit.

Medicare Part A

Part A (hospital insurance) of Original Medicare doesn't cover emergency room visits because the ER is considered outpatient care, not inpatient. However, should an ER visit lead to a hospital admission within three days of your initial visit, Part A will cover your treatment as the emergency room visit will be considered a part of your inpatient stay but only after you've met your $1,600 deductible . [1] Remember that between 2014 and 2017, 23% of ER visits led to hospitalizations for those 60 and up. [2]

Keep in mind, however, that you will have to pay your deductible over again for every pay period (60 days between receiving inpatient services). [1] This means you could pay multiple deductibles several times a year depending on how often you get inpatient care. Copays will also apply and can be as high as $800 depending on how long your stay is. [1]

Medicare Part B

Part B (medical insurance) is specifically designed to cover outpatient medical services, including emergency room visits. You will have to meet your yearly deductible of $226 as well as a 20% coinsurance . [1]

Additionally, you will pay a separate copay (typically 20% of covered services) for each Medicare-approved service you receive during your outpatient care. [1] If you are admitted to the same hospital for a related condition within three days of visiting the ER, you won't need to pay your copays as your visit will fall under inpatient care. [3]

Medicare Advantage

Also called Medicare Part C, Medicare Advantage plans provide Medicare coverage but the plans are issued by private insurance companies.

Similar to Original Medicare, Medicare Advantage plans must also cover emergency room visits. However, the copayments and other costs can differ, so it’s essential to consult your plan for details.

For instance, a Blue Cross Medicare Advantage Classic (PPO) plan can have a $90 copay for an ER visit while a CareFirst BlueCross BlueShield Advantage Core (HMO) plan can have a $95 copay. [4][5]

Medigap, or Medicare supplement insurance, can aid in covering the “gaps” in Original Medicare, such as copayments, deductibles and coinsurance. If you have a Medigap policy, it might cover some of the costs that Medicare Part B does not cover during an ER visit. You can enroll in Medigap once you have Original Medicare.

Original Medicare will typically require you to pay a copayment when visiting the emergency room. The copay amount can vary widely based on your coverage and the nature of the medical services received. For instance, Part A breaks down hospital copays as follows: [1]

Days 1-60: $0 after your deductible is met
Days 61-90: $400 every day
Days 91-150: $800 every day while using your 60 lifetime reserve days
After day 150: You pay all costs

Without Medicare coverage, the cost of an emergency room visit can be exorbitant with prices being $2,600 or higher depending on the provider. [6] Additional costs can be incurred for tests, treatments and if hospital admission is necessary.

How long can you stay at the hospital with Medicare?

Medicare Part A covers up to 60 days of inpatient hospital care for each benefit period after the beneficiary has met the Part A deductible. [7] Beyond 60 days, additional costs apply.

What is the Medicare deductible for an emergency room visit?

For emergency room visits under Medicare Part B, you'll generally need to meet the annual Part B deductible of $226 for this year. [1] Amounts can change yearly.

Does Medicare pay for emergencies?

Medicare does provide coverage for emergency situations, including emergency room visits, under Part B as well as if you have a Medicare Advantage plan.

Does Medicare cover ambulance rides?

Medicare Part B may cover ambulance services to or from a hospital or a skilled nursing facility when other transportation could endanger your health. However, you are typically responsible for 20% of the Medicare-approved amount. [8]

Will Medicare pay if I visit the ER twice on the same day?

Medicare Part B has a limitation on covering multiple visits in a single day; it will only cover two visits if they are for distinct, unrelated reasons. If a return visit occurs on the same day for an identical condition, the subsequent visit will not be eligible for coverage.

Medicare.gov. “ Costs .” Accessed September 1, 2023.
National Institutes of Health. “ Emergency Department Increased Use of Observation Care for Elderly Medicare Patients .” Accessed September 1, 2023.
Medicare.gov. “ Emergency Department Services .” Accessed September 1, 2023.
BlueCross BlueShield of New Mexico. “ Summary of Benefits ,” Page 6. Accessed September 1, 2023.
UnitedHealthcare. “ What Are My Care Options and Their Costs? ” Accessed September 1, 2023.
CareFirst “ Summary of Benefits ,” Page 4. Accessed September 1, 2023.
Medicare.gov. “ Inpatient Hospital Care .” Accessed September 1, 2023.
Medicare.gov. “ Ambulance Services .” Accessed September 1, 2023.
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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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Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-.

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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
Hawaii Laulima Data Alliance
Hawaii University of Hawai’i at Hilo
Illinois Department of Public Health
Indiana Hospital Association
Iowa Hospital Association
Kansas Hospital Association
Kentucky Cabinet for Health and Family Services
Louisiana Department of Health
Maine Health Data Organization
Maryland Health Services Cost Review Commission
Massachusetts Center for Health Information and Analysis
Michigan Health & Hospital Association
Minnesota Hospital Association
Mississippi State Department of Health
Missouri Hospital Industry Data Institute
Montana Hospital Association
Nebraska Hospital Association Services
Nevada Department of Health and Human
New Hampshire Department of Health & Human
New Jersey Department of Health
New Mexico Department of Health
New York State Department of Health
North Carolina Department of Health and Human Services
North Dakota (data provided by the Minnesota Hospital Association)
Ohio Hospital Association
Oklahoma State Department of Health
Oregon Association of Hospitals and Health Systems
Oregon Office of Health Analytics
Pennsylvania Health Care Cost Containment Council
Rhode Island Department of Health
South Carolina Revenue and Fiscal Affairs Office
South Dakota Association of Healthcare Organizations
Tennessee Hospital Association
Texas Department of State Health Services
Utah Department of Health
Vermont Association of Hospitals and Health Systems
Virginia Health Information
Washington State Department of Health
West Virginia Department of Health and Human Resources, West Virginia Health Care Authority
Wisconsin Department of Health Services
Wyoming Hospital Association
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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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
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Medicare emergency room copay.

Original Medicare pays for emergency room visits, but there is usually a copay for emergency room visits that the beneficiary needs to pay.

by Christian Worstell | Published October 25, 2023 | Reviewed by John Krahnert

Original Medicare is a federal health insurance program for seniors and people with certain disabilities. So does Medicare cover emergency room visits? When a Medicare recipient requires emergency care, Medicare does cover emergency room visits for the most part, and the recipient pays a copayment .

Read on to learn more about emergency room costs and how a Medicare Supplement Insurance plan can help reduce what you pay out of pocket for Medicare emergency room coverage.

What is the Copay for Medicare Emergency Room Coverage?

A copay is the fixed amount that you pay for covered health services after your deductible is met. In most cases, a copay is required for doctor’s visits, hospital outpatient visits, doctor’s and hospital outpatients services, and prescription drugs. Medicare copays differ from coinsurance in that they're usually a specific amount, rather than a percentage of the total cost of your care.

Medicare does cover emergency room visits. You'll pay a Medicare emergency room copay for the visit itself and a copay for each hospital service. It is important to remember, however, that your actual Medicare urgent care copay amount can vary widely, depending on the services you require and where you receive care.

If you are admitted for inpatient hospital services after an emergency room visit, Medicare Part A does help cover costs for your hospital stay. Medicare Part A does not cover emergency room visits that don't result in admission for an inpatient hospital stay.

What Does Medicare Pay for Emergency Room Visits?

Medicare Part A emergency room coverage is specifically for inpatient hospital stays. If your emergency room visit requires you to be admitted for inpatient care, your Medicare Part A benefits would kick in but are subject to the Part A deductible and coinsurance.

Most ER services are considered hospital outpatient services, which are covered by Medicare Part B . They include, but are not limited to:

Emergency and observation services, including overnight stays in a hospital
Diagnostic and laboratory tests
X-rays and other radiology services
Some medically necessary surgical procedures
Medical supplies and equipment, like splints, crutches and casts
Preventive and screening services
Certain drugs that you wouldn't administer yourself

NOTE: There's an important distinction to be made between inpatient and outpatient hospital statuses. Your hospital status affects how much you pay for services. Unless your doctor has written an order to admit you as an inpatient, you're an outpatient, even if you spend the night in the hospital.

How Medicare Part B Pays For Outpatient Services

Medicare Part B pays for outpatient services like the ones listed above, under the Outpatient Prospective Payment System (OPPS). The OPPS pays hospitals a set amount of money (or payment rate) for the services they provide to Medicare beneficiaries.

The payment rate varies from hospital to hospital based on the costs associated with providing services in that area, and are adjusted for geographic wage variations.

Other Medicare Costs

Aside from Medicare ER copays, there are other outpatient hospital costs that you should be aware of when visiting the emergency room, such as deductibles and coinsurance . In most cases, if you receive care in a hospital emergency department and are covered by Medicare Part B, you'll also be responsible for:

An annual Part B deductible of $240 (in 2024).
A coinsurance payment of 20% of the Medicare-approved amount for most doctor’s services and medical equipment.

How You Pay For Outpatient Services

In order for your Medicare Part B coverage to kick in, you must pay the yearly Part B deductible. Once your deductible is met, Medicare pays its share and you pay yours in the form of a copay or coinsurance.

Get Help Covering Your Emergency Room Copay

If you're worried about a trip to the emergency room adding expensive and unpredictable costs to your health care budget, consider joining a Medicare Supplement Insurance (or Medigap) Plan .

Medigap is private health insurance that Medicare beneficiaries can buy to cover costs that Medicare doesn't, including some copays. All Medigap plans cover at least a percentage of your Medicare Part B coinsurance or ER copay costs.

To find a Medigap plan in your area, call 1-800-995-4219 to connect with a licensed insurance agent.

Does medicare part a cover emergency room visits.

If you opted out of Medicare Part B, and only have Part A, you may be wondering if you can get coverage for an emergency room visit. Medicare Part A is designed for hospital insurance, meaning that it's benefits are generally used once admitted to the hospital. If your emergency room visit results in an inpatient admission, your Medicare Part A coverage would then kick in.

How Much is an Emergency Room Visit?

The average cost of an emergency room visit is around $1,150, although the average cost of an emergency room visit for those age 65 and over is just $849. ¹

Compare Medigap plans in your area.

Or call now to speak with a licensed insurance agent:

1-800-995-4219

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareSupplement.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox , MSN , and The Washington Post , and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.

https://consumerhealthratings.com/healthcare_category/emergency-room-typical-average-cost-of-hospital-ed-visit/

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Inpatient or outpatient hospital status affects your costs

Your hospital status—whether you're an inpatient or an outpatient—affects how much you pay for hospital services (like X-rays , drugs , and lab tests ). Your hospital status may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay.

You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day.
You're an outpatient if you're getting emergency department services , observation services, outpatient surgery , lab tests, or X-rays, or any other hospital services, and the doctor hasn't written an order to admit you to a hospital as an inpatient. In these cases, you're an outpatient even if you spend the night in the hospital.

Observation services are hospital outpatient services you get while your doctor decides whether to admit you as an inpatient or discharge you. You can get observation services in the emergency department or another area of the hospital.

The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need 2 or more midnights of medically necessary hospital care. But, your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.

Each day you have to stay, you or your caregiver should always ask the hospital and/or your doctor, or a hospital social worker or patient advocate if you’re an inpatient or outpatient.

Here are some common hospital situations and a description of how Medicare will pay. Remember, you pay your deductible , coinsurance, and copayment .

Remember, even if you stay overnight in a regular hospital bed, you might be an outpatient. Ask the doctor or hospital. If you have a Medicare Advantage Plan, your costs and coverage may be different. Check with your plan.

You may get a Medicare Outpatient Observation Notice (MOON) that lets you know you’re an outpatient in a hospital or critical access hospital. You must get this notice if you're getting outpatient observation services for more than 24 hours. The MOON will tell you why you’re an outpatient getting observation services, instead of an inpatient. It will also let you know how this may affect what you pay while in the hospital, and for care you get after leaving the hospital.

The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible.

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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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The information provided here is for educational purposes only. It does not constitute medical advice and is not a substitute for proper medical care provided by a physician. Cigna Healthcare SM assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of this information. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. In an emergency, dial 911 or visit the nearest emergency room.

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Emergency Room Services Coverage
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 ...
Medicare Part A and ER visits: Coverage and costs
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.
Medicare and emergency room visits: Coverage and limits
While very little data are available that relate specifically to the ER expenses of Medicare beneficiaries, the overall average cost of an ER visit is $1,917, according to the Healthcare Financial ...
Does Medicare Cover Emergency Room Visits?
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) Explore Humana Medicare Advantage plans.
Does Medicare Cover Emergency Room Visits?
Medicare covers emergency room visits throughout the United States, but it typically doesn't cover emergency care outside the U.S., except in limited circumstances. Some Medigap policies cover foreign travel emergency care with a lifetime limit of $50,000. Some Medicare Advantage plans provide limited coverage for foreign travel emergencies.
Medicare coverage for emergency room visits
Call us. 1-833-301-2052, TTY 711. Hours: 8 a.m. - 8 p.m. 7 days a week. Find an Agent. Medicare covers emergency room visits for injuries, sudden illnesses or an illness that gets worse quickly. Medicare Advantage also provides emergency room coverage.
Does Medicare Cover Emergency Room Visit Costs?
It's important to note that while Medicare does cover emergency room visits, there are costs associated with these visits. Medicare Part B typically covers 80% of the Medicare-approved amount for emergency room services after you meet the yearly Part B deductible. However, if you're admitted to the hospital as an inpatient after being ...
Does Medicare Cover Emergency Room Visits
Medicare coverage at the Emergency Room is necessary, emergencies can happen at any time. Learn about Emergency & Urgent Care coverage here! Speak with a Licenced Insurance Agent: (888) 335-8996. ... Does Medicare Advantage Cover the Costs of an Emergency Room Visit?
Does Medicare cover emergency room visits?
With original Medicare, the coverage of emergency room and urgent care visits falls under Part B. The costs include a 20% coinsurance after paying the annual deductible of $203. If an emergency ...
Does Medicare Cover Emergency Room Visits?
Medicare Part A will cover your visit to the emergency room if your doctor admits you to the same hospital for inpatient care within 3 days of your ER visit. Part A pays most of the cost of things like your room, meals, and nurse care and also pays for many treatment services you might receive while staying in the hospital as an inpatient.
Does Medicare Cover Emergency Room (ER) Visits?
Covers 80% of outpatient ER visit costs after you have reached your Part B deductible. You will also owe copayments for each service received. Part C (Medicare Advantage) Covers ER visits anywhere in the U.S. Costs for ER visits vary by plan. Part D (Prescription Drugs) N/A: Supplemental Insurance: Can help cover out-of-pocket costs related to ...
Does Medicare Cover Emergency Room Visits?
If you go to the emergency room and are admitted as an inpatient, Medicare Part A helps cover some of the costs related to your hospital stay once your Part A deductible is met. In 2024, the Medicare Part A deductible is $1,632 per benefit period .
Does Medicare Cover Emergency Room Visits?
Original Medicare does not have an established copay for emergency room visits. Instead, you will pay a share of the costs based on your Part A or Part B coverage, and which part of Medicare is applied to your visit. If you are admitted for at least two nights after and ER visit and Part A is used, in 2024 you will pay:
Does Medicare Cover Emergency Room Visits?
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.
How Much Does an ER Visit Cost? Free Local Cost Calculator
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. Medicare Part B covers 100% of most ER costs for most injuries, or if you become suddenly ill.
Does Medicare Cover Emergency Room Visits?
Without Medicare coverage, the cost of an emergency room visit can be exorbitant with prices being $2,600 or higher depending on the provider. [6] Additional costs can be incurred for tests, treatments and if hospital admission is necessary.
What is the average cost for an emergency room visit?
What is the average cost of an emergency room visit? ... Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Alternatively, you may be referred, via a link, to a selected partner website, which is independently owned and operated and may have different ...
How Much Does an ER Visit Cost in 2022? What to Know
Average Cost for ER Visits. In 2019, the average cost for an ER visit by an insured patient was $1,082. Those who were uninsured spent an average of $1,220. Average costs can vary by state and illness but range from $623-$3,087.
Costs of Emergency Department Visits in the United States, 2017
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 ...
Medicare Emergency Room Copay
If your emergency room visit results in an inpatient admission, your Medicare Part A coverage would then kick in. How Much is an Emergency Room Visit? The average cost of an emergency room visit is around $1,150, although the average cost of an emergency room visit for those age 65 and over is just $849. ¹
Inpatient or outpatient hospital status affects your costs
You come to the ER with chest pain, and the hospital keeps you for 2 nights. ... If you have a Medicare Advantage Plan, your costs and coverage may be different. Check with your plan. You may get a Medicare Outpatient Observation Notice (MOON) that lets you know you're an outpatient in a hospital or critical access hospital. You must get this ...
Emergency Room Visit: ER Costs & Wait Times
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 ...
Costs of Emergency Department Visits in the United States, 2017
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.

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Does Medicare Cover Emergency Room Visits?

Key Takeaways

How Much Does Medicare Pay for an Emergency Room Visit?

Does Medicare Part A or B Cover Emergency Room Visits?

Will Medicare Part A Cover Emergency Room Visits?

Does Medicare Have a Copay for ER Visits?

How Much of a Hospital Bill Does Medicare Pay?

Can I Get Help Paying?

How Many ER Visits Does Medicare Cover?

Who Covers Ambulance Transportation?

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Does Medicare Cover Emergency Room Visits?

Table of Contents

When to Go to the Emergency Room

How Medicare Covers Emergency Room Visits

Overall Eligibility Criteria

How Medicare Part A Covers Emergency Services

Part A Coverage Criteria

How Medicare Part B Covers Emergency Services

Part B Coverage Criteria

How Medigap Covers ER Visits

How Medicare Advantage Covers ER Visits

How Much Does an ER Visit Cost Without Medicare?

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

Putting It All Together

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

How Much Does an ER Visit Cost Without Insurance?

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How Much Does Medicare Cover for Emergency Room Visits?

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