Does Medicare Cover Urgent Care?
May 14, 2019
Reviewed and Updated by Kelsey Davis,
More than 89 million patients visit an urgent care facility each year. In fact, the number of facilities nationwide has increased from 6,400 to 8,100 since 2014 with roughly 600 more expected to open in 2019. Urgent care is a cost-effective way to get the care you need. If you’re wondering if Medicare covers urgent care, look no further, Medicare Plan Finder makes understanding your coverage easy.
Urgent Care Services Covered by Medicare
Urgent care is typically covered by Medicare Part B. It’s important to note that urgent care centers are not required to accept Medicare. While it’s rare for a facility to deny Medicare, it’s ultimately up to the centers and doctors. Part B covers lab tests, x-rays, emergency transportation, durable medical equipment, mental health, and partial outpatient hospitalization. Urgent care centers provide several services that fall under Part B including illness treatment, minor injury care, x-rays, lab tests, annual exams, and immunizations.
Does Medicare Part B pay for Urgent Care?
Yes, Medicare Part B would cover your urgent care costs if certain conditions apply:
- You are already enrolled in Medicare Part B
- Your Part B deductible ($185 in 2019) is met
- You visit an urgent care facility that participates in Medicare
What is the Medicare Copay for Urgent Care?
Typically, after your deductible is met, Medicare Part B will cover 80% of your costs. You will be responsible for a 20% copay. This may be different if you are enrolled in some sort of savings program or plan that covers Part B copayments (like certain Medicare Supplement plans).
Without insurance, urgent care visits can cost over $100. Imagine having to pay only $20 instead of $100!
What Does Medicare pay for Emergency Room Visits?
Medicare will typically pay up 80% of most services, including emergency room visits. That means that you will likely owe 20% of your emergency room bill. This again can differ if you have a certain Medicare Supplement plan or are part of a savings program that covers your copayments and coinsurance.
Urgent Care Near Me That Accepts Medicare
It’s important to know where the closest urgent care facility that accepts Medicare is. Don’t abuse your local emergency room. Go to an urgent care facility if you are feeling sick and can’t get a doctor’s appointment.
Click on your city below to see urgent care facilities in your area that accept Medicare (we’re adding more cities weekly). If your city is not yet listed, visit medicare.gov to search for facilities near you that accept Medicare.
How Much Does Medicare Pay for Urgent Care Visits?
Urgent care visits cost less than the emergency room, but can still cost $100 on average before insurance. Since urgent care centers cover a wide array of illnesses and injuries, it’s hard to estimate how much your visit will be. However, Medicare will cover 80% of your costs in urgent care. You will be responsible for the remaining 20% and up to $20 copay unless you are enrolled in a Medicare Supplement plan.
Medicare Supplements and Urgent Care
Medicare Supplement (Medigap) plans are financial benefits that can work alongside Original Medicare. They help to cover costs that Original Medicare does not including deductibles, copays, and coinsurance. There are ten plans available (A, B, C, D, F, G, K, L, M, and N), and each letter represents different coverage at a different price point. Medigap plans can help pay for the remaining 20% of your urgent care costs. For example, if you visit an urgent care facility, and had not met your deductible yet, and were billed with a $20 copayment and 20% coinsurance, Medicare Supplements could help with those costs. Depending on which plan you enroll with, you could pay as low as nothing out of pocket.
Medicare Advantage and Urgent Care
Medicare Advantage plans (MA) are required to provide, at a minimum, the same coverage as Original Medicare. This means that urgent care is still covered. However, MA plans offer several benefits that Original Medicare does not including dental, vision, or hearing coverage, and even group fitness classes like SilverSneakers®. It’s important to keep in mind that Medicare Advantage plans have networks so you will need to make sure the urgent care facilities you visit are covered. At Medicare Plan Finder, our licensed agents can help you enroll in a plan that offers the additional benefits you want with the network you need. Why wait? FIll out this form or give us a call at 844-431-1832. Appointments are no cost to you and there’s never an obligation to enroll.
Urgent Care vs. Emergency Room
Urgent care centers and emergency rooms both address your issues quickly and provide same-day relief. They are both covered under Medicare, but trips to the emergency room can leave you with higher out-of-pocket costs and can take longer to get the medical attention you need. It’s important to understand the difference between these facilities so you better understand where to go in the future.
Urgent care centers are intended for injuries or illnesses that are not life-threatening and cannot wait to be treated by your primary care physician. This includes injuries or illnesses like:
- Allergic reactions
- Muscle sprains
- Rashes, cuts, or scrapes
- Swelling or irritation
- Mild fever
- Cold or allergies
- Nausea, vomiting or diarrhea
- Sore throat
- Flu
Emergency rooms are for serious or life-threatening injuries and illnesses that need immediate attention. This includes injuries or illnesses like:
- Heart attack
- Stroke
- Chest pain
- Coughing up blood
- High fever
- Loss of consciousness
- Severe wound
- Major fracture
- Serious burn
Enroll Today
If you’re interested in enrolling in a Medicare Advantage or Medicare Supplement plan, fill out this form or give us a call at 844-431-1832. Our agents are happy to answer any questions regarding plans in your area, eligibility requirements, coverage, costs, and so much more.
