ER Visits Average 162 Minutes as Hospital Cost Pressures Mount

The number that didn't move

The typical American emergency room visit now lasts more than two and a half hours. The more telling detail is that this figure has stopped improving, even as the money propping up emergency care starts to shrink. New figures from the Centers for Medicare and Medicaid Services (CMS) put the median time in a hospital emergency department at 162 minutes for the 12 months ending September 30, 2025, unchanged from the year before.1 Axios analyzed the data and found that median visit lengths rose in 24 states and the District of Columbia. Oregon and Arkansas each added 15 minutes, while 20 states got faster.1 Nationally, about 2% of patients walked out before anyone saw them.1

The spread between places is wide. Washington, D.C., had the longest median visit at 303 minutes, roughly five hours.1 Maryland followed at 246 minutes and Rhode Island at 223. Most of the slowest states are in the dense Northeast corridor, including Delaware, Massachusetts and New York.13 North Dakota was fastest. Axios put its median at 110 minutes, while other coverage of the same release reported 101.113

The reports don't fully agree on the numbers. The Axios map caption gives a national median of 153 minutes, but its text and other outlets use 162.113 Some coverage says "average" when the CMS figure is a median.13 Third-party trackers using earlier CMS releases have reported anywhere from 2 hours 35 minutes to 2 hours 42 minutes.919 Whichever number you pick, the trend is the same: ER visits have been stuck at about two and a half to three hours for years. A Fox News review of the 2021–2022 data put the national figure at 160 minutes, up from 143 in 2020.14

Time in the ER costs money

It's easy to treat ER waits as a patient-experience issue. The stronger argument is that they are a cost issue. Axios notes that longer visits often mean longer waits to see a clinician, which drives both bad experiences and higher costs across the health system.1 Every hour a patient spends in an ER bed is an hour of staffed, equipped emergency space that no one else can use. That space is among the most expensive in a hospital.

Patients see this most clearly in the facility fee, the charge for using the emergency department at all. One analysis of negotiated rates at more than 4,000 hospitals found median facility fees of $201 for the lowest-severity visit and $1,250 for a life-threatening one. That's before physician fees, labs or imaging.22 Cash prices vary far more. A review of posted prices at 285 hospitals found Level 5 facility fees ranging from $108 to $17,730 for the same billing code, a 164-fold gap.25 Several of the most expensive hospitals in that sample were in the Denver area.25

The totals add up quickly. Cost guides put a typical uninsured visit for a common condition at $1,000 to $2,500. Serious emergencies can reach five or six figures, especially with surgery and an inpatient stay.2426 A chest-pain workup with an EKG, labs and a CT scan is commonly estimated at $4,000 to $10,000, and an ER visit that turns into an admission at $15,000 to $50,000 or more.22 Insurance helps but doesn't make the bill disappear. Insured patients typically pay roughly $150 to $700 out of pocket after copays and coinsurance.29

These price estimates come from consumer guides and price-transparency analyses, not the CMS release. Their exact figures differ, but they all point the same way. The ER is the most expensive place to get routine care, and a long stay usually means more tests, more monitoring and a bigger bill.

Boarding: the bottleneck after the decision to admit

Much of the delay happens after a doctor has already decided a patient needs a hospital bed. A JAMA study published in August looked at general-medicine boarders at 56 hospitals. It found that 23% waited at least four hours to move from emergency care to inpatient management, and many waited 12 to 24 hours.41 The four-hour mark comes from the Joint Commission, which treats boarding beyond that point as a patient-safety problem.41

The study found these waits were more common at larger hospitals, teaching hospitals and hospitals that serve more Medicaid patients.41 Lead author Alex Janke of the University of Michigan said some hospitals reliably finish the handoff in under four hours while others take more than a day. In his view, the gap depends on how a hospital organizes the work, not just on how full it is.41 Earlier University of Michigan research found that more than a quarter of admitted ED patients waited at least four hours for a bed in non-peak months. In winter the share was closer to 35%, and by 2024 nearly 5% of winter admissions waited a full day.18

Who waits also tracks with insurance. One study found that after adjusting for other factors, Medicaid patients boarded about 85 minutes longer than commercially insured patients, and Medicare patients about 67 minutes longer. Boarding matters for safety as well as cost. A five-year review at a Boston academic center found that patients who were themselves boarding were 1.6 times as likely to experience an error in their care.46

Medicaid cuts hit an already strained system

The flat 162-minute median arrives just as the financing behind emergency care is changing. Axios describes hospitals facing a "perfect storm": Medicaid funding cuts, scrutiny of the federal 340B drug-discount program and a move toward site-neutral payments.11 Coming changes to insurance eligibility and costs could lead people to put off care until it becomes a crisis, which would push even more of them into emergency departments.1

The scale is large. The 2025 tax law cut nearly $1 trillion from Medicaid over a decade, adding work requirements and shorter eligibility periods.31 STAT reports that about 7.6 million Americans are expected to lose coverage nationwide.40 Federal cuts to Medicaid disproportionate share hospital (DSH) payments took effect in October 2025 and reduce hospital funding by about $8 billion a year.37 As of October 1, 2026, most lawfully present immigrants, including refugees and asylum recipients, are no longer eligible for Medicaid.35

The effect on ERs is fairly direct. Federal law requires hospitals to stabilize anyone who arrives at the ER, so when more patients are uninsured, the hospital absorbs the cost.33 The California Hospital Association expects uncompensated care in the state to double from $2 billion to $4 billion a year, and more than half of California hospitals already operate at a loss.33 Earlier Commonwealth Fund modeling of a full rollback of Medicaid expansion projected that safety-net hospitals' operating margins could fall by 56%.32 That's a more severe scenario than current law, but it shows how exposed these hospitals are.

Who pays

The experts quoted in this coverage disagree here. Some argue that uncompensated care moves through the system as higher premiums and out-of-pocket costs for insured patients.34 CalMatters' reporting is more cautious. Studies suggest hospitals absorb about 80% of the added cost when uninsured patients increase, and some economists argue hospitals are already charging insurers close to the maximum, which leaves little room to pass costs on.31

Our view: the bigger risk is reduced access, not premium increases. When hospitals absorb losses, they tend to cut staff, close expensive service lines or shut down entirely.31 California hospitals have already laid off more than 3,000 workers in preparation for the cuts.31 In Maine, STAT reports that hospitals have closed birthing centers and leaders expect fewer hospital services overall, which leaves emergency and transport services to fill the gaps.40 Over a longer period, the U.S. lost a net 216 hospitals and more than 24,000 beds between 2010 and 2025. Closure rates in cities were similar to those in rural areas.

Fewer beds and fewer hospitals mean more boarding, which means longer ER stays. Longer stays cost more per patient, while hospital revenue falls. Beth Feldpush of America's Essential Hospitals told Axios that longer ER waits come with consequences ranging from delayed care to lost services.1

What to watch

Cutting ER wait times is one goal of a federal effort to improve health care by 2030. Axios also notes that a 2025 review found AI tools have begun to help shorten waits.12 The JAMA boarding study suggests a cheaper fix in some cases: hospitals could start inpatient care sooner for patients stuck in the ER, rather than waiting for a bed to open.41

The 162-minute median is a lagging indicator. It covers a period before most of the Medicaid changes took effect. The next CMS release, which will include more uninsured patients, fewer DSH dollars and continued hospital closures, will show whether ER visits stay flat or start getting longer and more expensive.