er visit on medicare

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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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. 

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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?

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.

Can I bundle multiple benefits into one plan?

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.

What Medicare coverage is right for my specific situation?

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.

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If you have Original Medicare , Part B covers emergency room services anywhere in the U.S. Medicare Advantage Plans also must cover emergency room services anywhere in the country. Emergency room services are typically provided when you have a medical condition that requires immediate action, such as an injury or sudden illness.

If you have a Medicare Advantage Plan, be aware that:

• Your plan cannot require you to see an in-network provider .
• You do not need a referral .
• There are limits on how much your plan can bill you if you receive emergency care while out of your plan’s network , Specifically, you will be billed either $50 or your plan’s in-network cost for emergency services, whichever is less.
• Your plan must cover medically necessary follow-up care related to the medical emergency if delaying care would endanger your health.
• You have the right to appeal if your plan does not cover your emergency care.

If your condition was not an emergency but appeared to be an emergency, Original Medicare or your Medicare Advantage Plan must still cover your care. For example, let’s say you have chest pain and think you are having a heart attack. If you go to the emergency room and doctors discover that your pain is heartburn, your care should still be covered because the situation appeared to be an emergency.

Even if you do not have health insurance or the ability to pay, you still have the right under federal law to receive medical care in the case of an emergency.

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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.

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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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Will Medicare Cover Emergency Room Visits?

Seniors account for more trips to the ER annually than any other age group. Falls, strokes, pain, and reactions to medications are just a few of the reasons people over the age of 65 visit the emergency room. Any trip to the emergency room can be stressful, but when you experience an injury, sudden illness, or medical event, you shouldn’t have to worry about the cost of the visit. If you are eligible for Medicare, you may get help paying for your trip to the ER.

Eligible for Medicare?

If you are 65 years of age or older, or have received Social Security benefits for 24 months, you will likely be automatically enrolled in premium-free Medicare Part A if you’ve paid Medicare taxes while working. When you first qualify for Medicare, you have the option of enrolling in Part B, or Medical Insurance. You pay a premium for Part B and will have a yearly deductible. Most Medicare recipients enroll in Part B during their Initial Enrollment Period to avoid paying late enrollment penalties. Part B benefits include coverage for doctor visits, preventive care, emergency department services under certain circumstances, and more.

How can Medicare help pay for your trip to the ER?

Anyone with Part B will be covered for trips to a hospital emergency room. You will pay a copayment for the emergency department visit and a copayment for each hospital service. You also pay 20% of the Medicare-approved amount for your doctor’s services and the Part B deductible applies. If you are admitted to the same hospital for a related condition within 3 days of your emergency department visit, you don’t pay the copayment because your visit is considered to be part of your inpatient stay.

Emergency services outside of the United States will only be covered in rare circumstances. If you travel abroad frequently and have Original Medicare, you may want to consider purchasing a Medigap policy. Medigap, also known as Medicare Supplement, policies may offer coverage for health services and supplies that you get outside of the United States. Medigap Plans C, D, G, M and N provide foreign travel emergency health care coverage.

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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.

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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.

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Will My Medicare Policy Cover a Visit to the ER?

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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.

On This Page

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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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.

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

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

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

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

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

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

How Much Does an ER Visit Cost Without Insurance?

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

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

Compare Procedure Costs Near You

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

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

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

How Much Does an ER Visit Cost With Insurance? 

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

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

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

Sample ER Visit Cost

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4 ER Alternatives Ranked by Level of Care

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

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

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

1. Charitable Hospitals  

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

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

2. Urgent Care Centers

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

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

3. Retail Health Clinics

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

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

4. Telehealth Visits

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

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

Tips for Taking Control of Your Health Care

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

Estimate the Cost of the ER Before You Need It

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

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

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

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

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

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How to Identify Hospital Claims for Emergency Room Visits in the Medicare Claims Data

This article provides guidance on how to identify hospital emergency room claims from the Medicare files.

Hospitals submit claims containing ER services on a CMS-1450 form (aka UB-04). Their claims containing ER charges will be found in the inpatient claims data (Inpatient file or MedPAR file) and the outpatient claims file.

Claims in the Outpatient and Inpatient files are identified via  Revenue Center Code  values of 0450-0459 (Emergency room) or 0981 (Professional fees-Emergency room).

Claims in the MedPAR file are identified via the  Emergency Room Charge Amount  field when the amount is > $0.

Although one can assume ER patients found in the inpatient data were admitted to the hospital, one  cannot  assume ER patients found in the outpatient data were  not  admitted to the hospital. Because some patients are transferred to a different hospital for admission and some hospitals bill ER and inpatient services separately, determining admission status for those ER visits found in the Outpatient file requires linking to the inpatient data to find evidence of an admission.

Please note charges for one ER visit will be found in either the Outpatient claims  or  the Inpatient claims; a visit will not generate ER charges on both an inpatient claim and an outpatient claim.

In summary, to find ER visits:

• Outpatient files:  Revenue Center Codes 0450-0459, 0981
• Inpatient files:  Revenue Center Codes 0450-0459, 0981
• Inpatient MedPAR: Emergency Room Charge Amount > $0

Note regarding LDS data: The MedPAR Hospital National LDS  file does not include a beneficiary-level identifier and cannot be linked to other data files, including the Outpatient SAF LDS. The Inpatient SAF LDS and Outpatient SAF LDS files are necessary to identify all ER visits that resulted in a hospital stay when working with the LDS data.  RIF MedPAR files do contain beneficiary identifiers and can be linked to other RIF claims files.

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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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How do you help patients who show up in the ER 100 times a year?

Leslie Walker

Dan Gorenstein

The hope was that bringing many other services to people with high needs would stabilize their health problems. While the strategy has succeeded sometimes, it hasn't saved money. Douglas Sacha/Getty Images hide caption

The hope was that bringing many other services to people with high needs would stabilize their health problems. While the strategy has succeeded sometimes, it hasn't saved money.

Larry Moore, of Camden, N.J, defied the odds — he snatched his life back from a spiral of destruction. The question is: how?

For more than two years straight, Moore was sick, homeless and close-to-death drunk — on mouthwash, cologne, anything with alcohol, he says. He landed in the hospital 70 times between the fall of 2014 and the summer of 2017.

"I lived in the emergency room," the 56-year-old remembers. "They knew my name." Things got so bad, Moore would wait for the ER nurses to turn their backs so he could grab their hand sanitizer and drink it in the hospital bathroom.

"That's addiction," he says.

Then, in early 2018, something clicked, and turned Moore around. Today, he's more than five-years sober with his own apartment, and he has only needed the ER a handful of times since 2020. He's active in his church and building new relationships with his family.

Moore largely credits the Camden Coalition , a team of nurses, social workers and care coordinators for his transformation. The nonprofit organization seeks out health care's toughest patients — people whose medical and social problems combine to land them in the ER dozens of times a year — and wraps them in a quilt of medical care and social services. For Moore, that meant getting him medical attention, addiction treatment and — this was key for him — a permanent place to live.

"The Camden Coalition, they came and found me because I was really lost," Moore says. "They saved my life."

For two decades, hospitals, health insurers and state Medicaid programs across the country have yearned for a way to transform the health of people like Moore as reliably as a pill lowers cholesterol or an inhaler clears the lungs. In theory, regularly preventing even a few $10,000-hospital-stays a year for these costly repeat customers could both improve the health of marginalized people and save big dollars.

Larry Moore (left) in 2020 with staff members from the Camden Coalition. The housing and addiction treatment the organization helped him get has been life saving. Dan Gorenstein/Tradeoffs hide caption

Larry Moore (left) in 2020 with staff members from the Camden Coalition. The housing and addiction treatment the organization helped him get has been life saving.

But breaking this expensive cycle — particularly for patients whose lives are complicated by social problems like poverty and homelessness — has proved much harder than many health care leaders had hoped. For example, a pair of influential studies published in 2020 and 2023 found that the Coalition's pioneering approach of marrying medical and social services failed to reduce either ER visits or hospital readmissions . Larry Moore is the outlier, not the rule.

"The idea that someone should go to the emergency room 100 times in a year is a sign of deep, deep system dysfunction," says Jeff Brenner, the primary care physician who founded and led the Camden Coalition from 2002 until 2017. "It should be fixable. We're clearly still struggling."

Yet, Brenner and others on the frontlines of one of health care's toughest, priciest problems say they know a lot more today about what works and what misses the mark. Here are four lessons they've learned:

Lesson 1: Each patient needs a tailored, sustained plan. Not a quick fix

The Camden Coalition originally believed that just a few months of extra medical and social support would be enough to reduce the cycle of expensive hospital readmissions. But a 2020 study published in the New England Journal of Medicine found that patients who got about 90 days of help from the Coalition were just as likely to end up back in the hospital as those who did not.

That's because, frontline organizations now realize, in some cases this wraparound approach takes more time to work than early pioneers expected.

"That 80th ER visit may be the moment at which the person feels like they can finally trust us, and they're ready to engage," says Amy Boutwell, president of Collaborative Healthcare Strategies , a firm that helps health systems reduce hospital readmissions. "We do not give up."

Frontline groups have also learned their services must be more targeted, says Allison Hamblin , who heads the nonprofit Center for Health Care Strategies, which helps state Medicaid agencies implement new programs. Organizations have begun to tailor their playbooks so the person with uncontrolled schizophrenia and the person battling addiction receive different sets of services.

Larry Moore, for example, has done fine with a light touch from the Coalition after they helped him secure stable housing. But other clients, like 41-year-old Arthur Brown, who struggles to stay on top of his Type 1 diabetes, need more sustained support. After several years, Coalition community health worker Dottie Scott still attends doctor's visits with Brown and regularly reminds him to take his medications and eat healthy meals.

Aaron Truchil, the Coalition's senior analytics director, likens this shift in treatment to the evolution of cancer care, when researchers realized that what looked like one disease was actually many and each required an individualized treatment.

"We don't yet have treatments for every segment of patient," Truchil says. "But that's where the work ahead lies."

Lesson 2: Invest more in the social safety net

Another expensive truth that this field has helped highlight: America's social safety net is frayed, at best.

The Coalition's original model hinged on the theory that navigating people to existing resources like primary care clinics and shelters would be enough to improve a person's health and simultaneously drive down health spending.

Over the years, some studies have found this kind of coordination can improve people's access to medical care , but fails to stabilize their lives enough to keep them out of the hospital. One reason: People frequently admitted to the hospital often have profound, urgent needs for an array of social services that outstrip local resources.

As a result of this early work, Hamblin says, state and federal officials — and even private insurers — now see social issues like a lack of housing as health problems, and are stepping in to fix them. Health care giants like insurers UnitedHealthcare and Aetna have committed hundreds of millions of dollars to build affordable housing, and private Medicare plans have boosted social services , too. Meanwhile, some states, including New York and California, are earmarking billions of Medicaid dollars to improve their members' social situations, from removing mold in apartments to delivering meals and paying people's rent .

Researchers caution that the evidence so far on the health returns of more socially focused investments is mixed — further proof, they say, that more studies are needed and there's no single solution that works for every patient.

Some health care experts also still question whether doctors and insurers are best positioned to lead these investments, or if policymakers and the social service sector should drive this work instead.

Lesson 3: Recent boom in new programs demands better coordination

This spike in spending has led to a wave of new organizations clamoring to serve this small but complex population, which Hamblin says can create waste in the system and confusion for patients.

"All of these barriers to entry and handoffs don't work for traumatized people," former Coalition CEO Brenner says. "They're now having to form new, trusting relationships with multiple different groups of people."

Streamlining more services under a single organization's roof is one possible solution. Evidence of that trend can be seen in the nationwide growth of clinics called Certified Community Behavioral Health Clinics, These clinics deliver mental health care, addiction treatment and even some primary care in one place.

Brenner, who now serves as CEO of the Jewish Board, a large New York City-based social service agency with a budget of more than $200 million a year, is embracing this integration trend. He says his agency is building out four of that newer type of behavioral health clinic, and offering clients housing on top of addiction treatment and mental health care.

Other groups, including the Camden Coalition, say simply getting neighboring care providers to talk to one another can make all the difference. Coalition head Kathleen Noonan estimates the organization now spends just 25% of its time on direct service work and the rest on quarterbacking, helping to coordinate and improve what she calls the "local ecosystem" of providers.

Lesson 4: Rethink your definition of success, and keep going

Twenty years ago, the goal of the Camden Coalition was to help their medically complex patients stay out of the E.R. and out of the hospital — provide better health care for less cost. Noonan, who took over from Jeff Brenner as CEO of the Coalition, says they've made progress in providing better care, at least in some cases — and that's a success. Saving money has been tougher.

"We certainly don't have quick dollars to save," Noonan says. "We still believe that there's tons of waste and use of the [E.R.] that could be reduced ... but it's going to take a lot longer."

Still, she and others in her field do see a path forward. As they focus on improving their patients' mental and physical health by developing and delivering the right mix of interventions in "the right dose," they believe the cost savings may ultimately follow, as they did in Larry Moore's case.

The stakes are high. Today, homelessness and addiction combined cost the U.S. health care system north of $20 billion a year, wreaking havoc on millions of Americans. As health care delivery has evolved in the last two decades, the question is no longer whether to address people's social needs, but how best to do that.

This story comes from the health policy podcast Tradeoffs . Dan Gorenstein is Tradeoffs' executive editor, and Leslie Walker is a senior reporter/producer for the show, where a version of this story first appeared. Tradeoffs' weekly newsletter brings more reporting on health care in America to your inbox.

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Christopher gregor, nj dad accused in son’s treadmill death, walked out of er as medics struggled to save 6-year-old’s life: nurse testimony.

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The father whose son died days after he allegedly forced the boy to run at high speeds on a treadmill callously left the room while medics were struggling to revive the youngster, according to testimony from his New Jersey murder trial.

Christopher Gregor, 31, allegedly walked out of the emergency room as nurses were scrambling to keep his son Corey Micciolo alive — leaving the then-6-year-old to die in the company of strangers rather than a family member.

“We were the only ones with him,” testified Lindsay Carnevale, a nurse at the Southern Ocean County Medical Center who helped treat little Corey when he was brought in on the afternoon of April 2, 2021.

The boy had woken that day with slurred speech, trouble breathing and nausea, and by the time his father brought him to the hospital at nearly 4 p.m., doctors determined the child needed to be intubated.

Carnevale testified that Gregor was emotionless when he brought Corey in, according to the Asbury Park Press , and that he left the boy for a period before briefly returning and then finally walking out again moments later.

Corey was pronounced dead at 5:02 p.m., and less than 20 minutes later, surveillance footage showed his father driving away from the hospital.

Just over a week before Corey was brought to the hospital, his father had forced him to run on a treadmill at a local gym and turned up the speed until the boy was sent sprawling to the ground, disturbing video showed.

Gregor then picked his son back up and set him on the machine until he fell again several more times.

Days later, Corey’s mother Bre Micciolo reported injuries the child sustained in the incident to the New Jersey Division of Child Protection and Permanency, and the boy was taken to a hospital on April 1.

During that visit, Corey allegedly told doctors his father had forced him to run on the treadmill because he “was too fat.”

The next day, he was brought to the hospital again after waking up with frightening symptoms and suffered a seizure during a CT scan and died as staff tried to save him.

An autopsy ruled Corey’s death a homicide after it was determined he suffered blunt force trauma to his chest and abdomen, lacerations and contusions to both his liver and heart, and indications of chronic abuse.

Gregor faces 30 years to life in prison if he is convicted of murder.

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Increased Use of Medicare Telehealth During the Pandemic

Telehealth visits for Medicare beneficiaries have increased significantly since the COVID-19 pandemic began, according to a report from the US Department of Health and Human Services (HHS).

Medicare beneficiaries are making millions more telehealth visits since the COVID-19 pandemic began, according to a recent report.

Researchers in HHS' Office of the Assistant Secretary for Planning and Evaluation reviewed 2019 and 2020 Medicare health care utilization trends. The authors found that overall Medicare Part B visits—when accounting for both in-person and telehealth—decreased from 1.1 billion in 2019 to approximately 989 million in 2020. However, 2020 telehealth visits increased to 52.7 million from approximately 840 000 in 2019. Ninety-two percent of telehealth visits occurred in beneficiaries’ homes, which generally wasn’t permitted before the pandemic.

To reduce COVID-19 exposure in health care environments, the US Centers for Medicare & Medicaid Services (CMS) authorized waivers in March 2020 that expanded telehealth services for Medicare beneficiaries. These waivers allowed for telehealth in-home visits, services in urban areas, and audio-only interaction for some services.

HHS’ report noted that in 2020, a greater proportion of beneficiaries in urban than rural areas used telehealth services. Whereas Massachusetts, Vermont, Rhode Island, New Hampshire, and Connecticut were among states with the highest use of telehealth services in 2020, those with the lowest use included Tennessee, Nebraska, Kansas, North Dakota, and Wyoming. White Medicare beneficiaries were more likely to use telehealth services than Black beneficiaries.

Among clinicians, behavioral health specialists had the highest increase in telehealth visits. In 2019, only 1% of visits to behavioral health specialists were telehealth; in 2020, the percentage jumped to 38.1%. By the end of 2020, telehealth visits to behavioral specialists were as common as in-person visits.

“This report provides valuable insights into telehealth usage during the pandemic,” CMS Administrator Chiquita Brooks-LaSure, MPP, said in a statement . “CMS will use these insights—along with input from people with Medicare and providers across the country—to inform further Medicare telehealth policies.”

See More About

Suran M. Increased Use of Medicare Telehealth During the Pandemic. JAMA. 2022;327(4):313. doi:10.1001/jama.2021.23332

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