March 29th 2024
By Ari Parker
Urgent care centers are good for people with urgent, non-emergency health concerns. Learn how Medicare covers urgent care and what your costs will be.
By Ari Parker
You’ve likely been to urgent care at some point in your life. Going to an urgent care center is a good option if you need immediate medical attention, but you don’t need emergency care.
Because you aren’t receiving treatment or advice from your usual doctor’s office or healthcare provider, you may have questions around whether or not Medicare covers visits to an urgent care center.
Thankfully, urgent care centers take Medicare. What you pay for your visit to urgent care will depend on whether you have Original Medicare or Medicare Advantage.
Original Medicare and Medicare Advantage both cover urgent care visits.
With Original Medicare, you’ll pay 20% of the Medicare-approved cost for the service once you reach your deductible.
Your out-of-pocket costs for an urgent care visit will vary depending on which Medicare Advantage plan you have.
You typically need urgent care when you have an illness or injury that needs immediate medical attention but doesn’t require emergency room care. Some reasons you may need urgent care include:
Minor injuries like cuts, burns, or sprains
Illnesses like colds, flu, or urinary tract infections
Non-emergency allergic reactions
Minor fractures or dislocations
In some cases you may prefer to visit an urgent care center over your usual doctor even for common illnesses. If your doctor isn’t open or doesn’t have any appointments available soon enough, an urgent care center may be your best option. Urgent care centers can be more convenient and provide quicker service. This is because they accept walk-ins, are located in accessible areas, and offer extended hours.
While you can go to the emergency room for non-emergency injuries that require immediate attention (like minor fractures), it’s best that you reserve the ER for more serious conditions. You should go to the emergency room if you experience:
A heart attack
A stroke
Seizures
Broken bones
Serious burns
Head injuries
Uncontrollable bleeding
Suicidal thoughts
Serious wounds
Yes, urgent care centers take Medicare and the visit is usually less expensive than going to the emergency room. If you have Original Medicare, you’ll pay 20% of the cost of your service once you’ve met your Part B deductible.
Emergency room services, on the other hand, are more costly. You’re responsible for a copayment for each emergency department visit and each service you need for a short-term visit. On top of that, you’d still need to pay 20% of the Medicare-approved amount for services after you reach your Part B deductible. That’s why you generally should go to an urgent care center near you rather than the emergency room if you don't have a life-threatening situation.
Since you won’t have access to your primary care doctor while you’re traveling, you may need services from an urgent care center. If you’re traveling domestically, Original Medicare should have you covered! Original Medicare doesn’t limit you to provider networks, so any urgent care center that accepts Medicare will be covered.
If you’re traveling internationally, Original Medicare doesn’t provide coverage, but some Medicare Supplement plans provide international healthcare coverage.
Yes, you can pay for urgent care visits with Medicare Advantage plans. However, your out-of-pocket costs won’t be the same as with Original Medicare. Medicare Advantage plans are offered by private companies and the deductibles and coinsurance are different from one plan to another. Additionally, most Medicare Advantage plans have provider networks, which can limit your coverage to certain facilities and healthcare providers. You may have to be careful about which urgent care centers you visit so you don’t end up paying too much.
If you have questions about how your Medicare Advantage plan covers a visit to the urgent care center near you, you can contact your insurance provider or call the urgent care facility.
If you don’t have a Medicare Advantage plan that operates under a provider network, you can use online search engines to find urgent care facilities in your area. You’ll often find a center’s address, reviews, and contact information this way.
If you do have a Medicare Advantage plan, you can search providers using your insurance’s online platform. Many insurance carriers provide directories that show which facilities near you take your insurance. Your primary care physician may also give you recommendations for in-network urgent care centers.
It’s never a good feeling when an unexpected health issue arises, especially if you aren’t able to see your usual doctor. Our Medicare Advisors can help you understand what your insurance plan covers or switch to a plan with better coverage for your needs. Contact us at 855-900-2427 or schedule a time to talk for a free consultation tailored to your healthcare needs.
