Does Medicare Cover Urgent Care?
Today in the United States there are over 9,000 urgent care centers in towns and cities across the country. Urgent care centers are on-demand care outlets where medical professionals provide care for people whose illnesses or injuries can’t be taken care of in a doctor’s office but don’t require going to a hospital emergency room.
To get a clearer idea of what medical conditions warrant a trip to an urgent care center, here are a few examples:
- Cuts that might require stiches but aren’t bleeding excessively
- Mild to moderate breathing problems
- Fever
- X-rays and lab tests for diagnostics
- Skin rashes and infections
- Urinary tract infections
- Vomiting or diarrhea
- And others
On the other hand, it’s important to remember that in serious emergency situations like the ones listed below, you should call 911 right away and get emergency medical help:
- Loss of consciousness, convulsions, or seizures
- Gunshot wounds, knife wounds, or other wounds that are serious
- Heavy bleeding
- Burns that are moderate to severe
- Compound fracture (bone protruding the skin)
- Poisoning or suspected drug overdose
- Symptoms of a heart attack
- Severe pain
- And others
Knowing that you have an urgent care center close to you is comforting. But if you need urgent care services, does your Medicare insurance help cover the cost?
Does Medicare cover urgent care services?
Original Medicare
If you need urgent care to treat a sudden illness or injury that isn’t a medical emergency, Original Medicare Part B (medical insurance) covers a portion of the cost of the urgent care visit.
If the urgent care center accepts Medicare assignment, then Medicare Part B pays 80 percent of the final approved cost of your visit for services and tests you get there. You pay the remaining 20 percent after you have met your annual Part B deductible.
If the urgent care center you visit doesn’t accept Medicare assignment, you may have to pay more out-of-pocket for services and tests you receive, but you can’t be refused care. However, if you have a choice of centers, you should choose one that accepts Medicare. Many urgent care centers accept Medicare, but you can call before visiting a location near you to be certain.
Original Medicare Part B coverage for urgent care doesn’t include any prescriptions for medication that a physician prescribes during your care. However, if you have a Medicare prescription drug (Part D) plan, you may have coverage if the drug is on the Part D plan’s formulary (list of covered drugs).
Medicare Advantage (Part C)
Medicare Advantage plans offer the same coverage as Original Medicare Parts A and B do. Most plans also include extra benefits and additional coverage like prescription drugs. Because Original Medicare covers urgent care, your Part C plan must also cover it.
However, depending on the type of plan you have, you may have different coinsurance or copayment charges for your care. And some Medicare Advantage plans have a pre-determined allowance for urgent care you get on an annual basis.
Your Part C plan may also ask you to use urgent care centers that are included in the plan’s network of providers. You can find this information on your printed policy, on the plan’s website, or by calling your provider. In some cases, you may pay more if you use a facility that isn’t in the plan’s network.