Does health insurance cover ER visits?
Your health insurance will cover a trip to the emergency room, whether the hospital is in-network or out-of-network. However, emergency room visits are subject to copays, coinsurance, and deductibles depending on your policy. Although the network doesn’t matter for emergency care, if you are admitted to an out-of-network hospital, you may have to pay higher coinsurance amounts.
Why did I get a bill for an emergency room visit?
You will receive a bill for an emergency room visit if your plan requires you to pay a copay or coinsurance, or if your deductible applies to the services you received. A higher-than-expected ER bill may be due to services that are not covered by your plan. If the bill includes out-of-network charges for emergency care, check whether federal law protects you from those charges before paying.
Common reasons for a higher-than-expected bill include:
- An out-of-network provider cares for you during a hospital visit or stay.
- Your insurer deems your issue wasn’t an emergency, and you should have sought care at a more appropriate care location, such as a doctor’s office or retail clinic.
Health insurance companies have contracts with hospitals and providers. Health plans cover emergency room claims, but a doctor or technician may not be in your health plan’s network. In that case, you might get a larger-than-expected bill if one of the professionals who cared for you is out of network.
The other occasion when you might receive a larger bill is if you go to the emergency room for non-emergency care. Some insurers nudge members to get lower-cost care rather than go to an emergency room unless it’s an actual emergency. This will also save you money on coinsurance.
Those lower-cost care locations include a primary care provider’s office, an urgent care center or a health clinic. Insurers want members to get care at those locations for non-emergencies. Doing so not only reduces health costs for health plans but also minimizes the chance of overcrowded emergency rooms.
Health insurers may reject a claim for an emergency room visit that they deem unnecessary. It's uncommon, but it does happen. If that's the case, you will need to appeal.
What to do if you get a surprise emergency room bill
If you receive an unexpected ER bill, compare it with your insurance explanation of benefits (EOB) and ask your insurer to explain any charges you don't understand. If the bill includes incorrect charges or violates federal protections against surprise billing, dispute it with your insurer and the hospital.
Follow these steps:
- Review your hospital bill and EOB. Compare the services, billed amounts, insurer payments, and your stated responsibility. Look for duplicate charges, incorrect cost-sharing, or out-of-network fees that violate federal protections.
- Contact your insurer. Request that it negotiate a lower rate with the hospital for your charges. You can also appeal the surprise bill to the insurer.
- Contact the hospital's billing department. Ask them to correct billing errors and remove charges that violate the No Surprises Act. If you owe a legitimate balance, ask about financial assistance or a payment plan.
- File a complaint if the issue remains unresolved. Contact the federal No Surprises Help Desk at 1-800-985-3059 or visit CMS's Medical Bill Rights page. Your state insurance department also helps with certain insurance disputes.
You can also check out the National Patient Advocate Foundation, which offers help on its site on appealing surprise medical bills, including template appeal letters.
Silver plans provide a good balance of monthly premiums with out-of-pocket costs. Coinsurance is 70% with a silver plan, meaning you will pay 30% of the costs after your deductible is met, up to the out-of-pocket limit. Silver plans are a good choice for people who are in generally good health but don't want high out-of-pocket costs if something goes wrong. Bronze plans are a popular choice with those who value low monthly premiums and are willing to pay more when they need care. Coinsurance is set at 60%, meaning you will pay 40% if you do need care, up to the out-of-pocket limit. Bronze plans are good for those who don't expect to need many services outside of preventative care throughout the year.
ACA platinum plans have the highest monthly premiums, but the lowest out-of-pocket costs. You'll pay more monthly in return for lower deductibles, copays and coinsurance amounts. Coinsurance with platinum plans is 90%, which means you pay 10% after the deductible, up to your out-of-pocket limit. Platinum plans are good for those who anticipate a lot of medical needs throughout the year.
Gold plans cost a little less than platinum plans, and come with higher out-of-pocket costs. The coinsurance amount on a gold plan is 80%, which means you pay 20% after the deductible, up to your out-of-pocket limit. A gold plan is a good idea if you think you'll need a lot of care throughout the year, but don't want to pay platinum premiums.Health insurance finder tool
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Preferred-provider Organization (PPOs)
Preferred-provider organization (PPOs) plans are the most common type of
employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but
those added costs offer you flexibility. A PPO allows you to get care anywhere
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out-of-network care, but a PPO will pick up a portion of the costs.
Find out more about the differences between plansHealth maintenance organization (HMO)
Health maintenance organization (HMO) plans have lower premiums than PPOs.
However, HMOs have more restrictions. HMOs don't allow you to get care outside
of your provider network. If you get out-of-network care, you'll likely have to
pay for all of it. HMOs also require you to get primary care provider referrals
to see specialists.
Find out more about the differences between plansHigh-deductible health plans (HDHPs)
High-deductible health plans (HDHPs) have become more common as employers look
to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but
much higher deductibles. A deductible is what you have to pay for health care
services before your health plan chips in money. Once you reach your deductible,
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coinsurance.
Find out more about the differences between plansExclusive provider organization (EPO)
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with
the restricted network found in an HMO. EPOs don't require that members get a
referral to see a specialist. In that way, it's similar to a PPO. However, an
EPO requires in-network care, which is like an HMO.
Find out more about the differences between plans
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Know more individual insurance / ACA 
Can you buy emergency health insurance?
No, emergency-only health insurance is not a standard category on the ACA Marketplace. Catastrophic health insurance is the closest ACA option, but it covers essential health benefits, not just emergency care. It also has a high deductible and strict eligibility requirements.
You may wind up with a hefty hospital bill if you visit an emergency room without insurance, but they must care for you in an emergency.
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August 4, 2026
