Will Medicare Cover Emergency Room Visits?

Medicare Benefits Solutions
Sep 21, 2020

Medical emergencies can be scary, and unfortunately, they can also be expensive. On average, a medical emergency can cost you thousands of dollars. But in severe cases, or cases involving prolonged hospitalization, the price tag of emergency medical care can easily reach the tens or even hundreds of thousands of dollars.

Medicare Coverage for ER Visits

Unfortunately, medical concerns tend to pop up more frequently as we get older. This concern is compounded for seniors on a fixed income as an expensive medical emergency can cause you to go into deep debt. Although you may already know that Medicare is available to help pay for things like outpatient treatment in your doctor’s office, you may be wondering whether Medicare coverage will provide benefits if you need care during an emergency room visit.

Thankfully, Medicare does provide coverage for emergency room visits through Part B, and you can also receive coverage for your hospital stay under Part A if you are formally admitted to a hospital for further treatment. Medicare Part B offers coverage for outpatient procedures, so if you visit an emergency room with a broken bone or are seen by a physician regarding the sudden onset of a medical condition, your care is covered as long as your Part B coverage is current.

If you are admitted to a hospital or a skilled nursing facility pursuant to a medical emergency, your coverage then switches to Medicare Part A. This also applies if you need to be admitted to a skilled nursing facility following an injury or while recovering from a medical procedure.

Follow-up Medical Care Coverage

After your emergency medical care needs have been addressed, you may need to schedule a follow-up appointment with the hospital or your primary care physician for things like monitoring and testing. In these cases, Medicare Part B will once again be the section of Medicare that is billed for care costs.

If you require prescription drugs to continue your care at home, these medications will be covered under Part D of Medicare as long as you’ve opted for Part D coverage, your premium is current and your prescription is covered under your plan’s formulary.