Urgent care centers are becoming increasingly popular across the country, as they’re often convenient and have short wait times. Fortunately, Medicare has coverage for many services at urgent care centers.
What Do I Need to Know About Medicare Urgent Care Coverage?
Just like with any other healthcare provider, you need to make sure that the urgent care center accepts Medicare before you go, or you risk paying for the costs yourself. You can determine if the urgent care center, or any other provider, accepts Medicare simply by calling them and asking. If you need to locate a center that accepts Medicare, you can use Medicare’s online tool. It’s always wise to confirm that the provider accepts Medicare before your visit, in case they’ve made recent changes that haven’t been reflected online yet.
If you’re traveling, we recommend that you make a note of the urgent care centers available near your destination. You could also bookmark Medicare’s tool for easy retrieval should you need it.
What Does Medicare Pay for Urgent Care Visits?
Urgent care is primarily covered under Medicare Part B. This means that whatever you currently pay to see the doctor will most likely be what you have to pay at an urgent care facility. Your costs can vary based on the type of coverage you have:
- Original Medicare: If you only have Original Medicare (Medicare Part A and Part B), you’ll most likely need to pay for 20% of your visit, as well as any applicable deductibles and copays. There’s no cap on the 20% coinsurance for services that Medicare covers, so your total out-of-pocket cost will depend on what your bill is.
- Medicare Supplement Plans: You can use your Medicare Supplement plan anywhere that accepts Medicare. Medicare Supplement plans will pay their portion as long as Medicare pays first. For instance, if you have Medicare Supplement Plan F and Medicare pays its portion for each service, you shouldn’t have any out-of-pocket costs. If you have Medicare Supplement Plan N, which doesn’t cover copayments, you may be required to pay the Medicare urgent care copay of up to $20 up front.
- Medicare Advantage Plans: Medicare Advantage plans are a form of private insurance and are primary instead of Medicare. If you have an Advantage plan you should review your policy for details on networks, costs, and coverage.
What Urgent Care Services are Covered by Medicare?
Any of the approved services that you would receive by your doctor should also be covered at an urgent care center. These services include, but aren’t limited to:
- Annual physicals
- Some vaccinations
- Treatment for non-life-threatening illness
- Lab work
What Happens If I Use an Urgent Care Center That Doesn’t Accept Medicare?
If you receive treatment at an urgent care center that doesn’t accept Medicare, you’ll most likely have to pay the entire cost out-of-pocket. Medicare may reimburse you if your treatment was an emergency, but it’s best to avoid taking a financial risk by choosing a center that accepts Medicare.
Overall, urgent care centers can be convenient when you need minor injuries or illnesses treated. In order to make sure that your services are covered, you need to seek treatment at a center that accepts Medicare. Otherwise, you risk paying for the entire cost yourself. A Medicare Supplement plan can help cover the Medicare coinsurance and copays, but if you have a Medicare Advantage, plan your network, coverage, and costs may vary.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.