Does Medicare Cover Emergency Room Visits?

May 26th, 2017     Medicare

Emergency room visit is covered by Medicare Part B. So, if a person has medicare part B, then it is covered, however, the patient has to pay a co-payment for these services just like any other part-B covered services. If the person is hospitalized after the ER visit, then he/she will be covered through Medicare Part-A and will have to borne the corresponding Part A deductible and coinsurance.

How often it is covered?

Medicare Part B covers benefits for emergency room visits. The services of emergency room department are offered when a person has an injury, sudden illness or an illness that gets much worse quickly.

Eligibility Criteria

All persons who are part of Medicare Part B are covered.

Costs For Emergency Room Visit

  • A person has to pay a co-payment for each visit to emergency department and a co-payment for each hospital service.
  • A person has to pay 20% of the Medicare-approved amount for the doctor’s services, and the Part B deductible is also included.
  • If a person is admitted to the same hospital for a related condition with 3 days of the emergency room visit, then he/she don’t pay the co-payment because the visit is considered as inpatient stay (and it comes under Medicare Part A).

Inpatient or outpatient hospital status during Emergency Visits affects costs.

Here are some common scenarios in an emergency case and a description of how Medicare will pay. Remember, the patient will be responsible for his/her deductible, co-insurance, and co-payment.

Situation Inpatient or Outpatient Part A pays Part B pays
If a person is in the Emergency Room (ER) and then he is hospitalized formally with a doctor’s order. Outpatient until admitted formally to the hospital (on doctor’s order). Inpatient following such admission. his Inpatient hospital stay. his doctor services and other outpatient services in ER.
If a patient visits the ER and is sent to the intensive care unit (ICU) for close monitoring. His doctor expects him to be sent home the next morning unless his condition worsens. His condition resolves and he is sent home the next day. Outpatient. Nothing. Your doctor services.
If a person comes to ER with chest pain, and the hospital keeps him for 2 nights. One night is spent in observation and the doctor writes an order for inpatient admission on the second day. Outpatient until admitted formally to hospital (on doctor’s order). Inpatient following such admission. his Inpatient hospital stay. Doctor services and hospital outpatient services (for example, ER visit, observation services, lab tests, or EKGs)

Emergency Hospital Transportation

A person can get emergency ambulance service when he had a sudden medical emergency, and his health is in serious danger because he can’t be safely transported by other means, like by car or taxi. The ambulance services are covered under Part-B.

Below are the examples of when Medicare might cover emergency ambulance transportation.

  • If a person is in shock, unconscious, or bleeding heavily.
  • If a person needs skilled medical treatment during transportation.

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