Does Medicare Cover Urgent Care Visits?

Utilizing urgent care and the services provided can be helpful for Medicare beneficiaries who feel as if they need immediate treatment for slightly minor conditions, or do not want to bare the costs of Emergency room visits. Medicare may offer a portion of coverage for these visits based on the facility itself, and the specific treatment needed for the patient. Understanding what each Medicare plan covers and what the costs may be is significant.

What Part of Original Medicare Covers Urgent Care Visits?

If you currently have Original Medicare, your coverage is broken down into Part A and Part B coverage.

If the urgent care facility accepts Medicare, then Medicare Part B may cover visits and treatments received for unexpected injury or illness. However, it will only pay 80% of the total cost of your visit considering your Part B deductible has been met.

It is suggested to call and ask the urgent care about their options prior to visiting. You may also be able to find this information on the urgent care’s website.

Can a Medicare Supplement Plan Help with Urgent Care Costs?

If you’ve selected to purchase a Medicare Supplement Plan (Medigap), you may have some additional support:

Medicare Supplement Plan N may provide you with some relief from the out-of-pocket costs associated with a trip to the urgent care.
Plan N helps to bring down the out-of-pocket costs for the Medicare Part B coinsurance.
Plan N typically requires a small copay for doctor visits of $20.

For more information visit Medicare Supplement Plan N, and Medicare Supplement Plan F.

If you choose to have another supplement plan, such as Plan F, you may not have to pay any out-of-pocket costs for this trip to the urgent care.

Is There Coverage Under Medicare Advantage Plans for an Urgent Care Visit?

Some enrollees decide not to keep Original Medicare. They switch to a Medicare Advantage Plan instead. If you elected to go this route, your coverage is dependent on what’s written into your Medicare Advantage Plan. This may differ from one plan to the next, here are some helpful tips for figuring out coverage:

Most urgent care centers accept Medicare Advantage plans. However, you will need to choose an urgent care that operates within the network of providers you’re able to choose from based on your plan’s rules.
Contact your Advantage Plan provider to determine which urgent cares in your area are in network. Use those to minimize any extra costs associated with your care.
If you have an HMO, you may not receive any coverage for an out-of-network urgent care. That’s why it is important to know which local facilities you can visit when there’s a need for care.
Be sure you know how much coverage you have for an urgent care visit. The amount of your deductible and other costs depends on the policy you’ve selected.

Do You Have the Coverage You Need?

It’s challenging to know how to get care in some situations. If you’ve received a bill for urgent care visits, you can contact your Medicare provider to verify if it is accurate. You may be able to file a Medicare reimbursement claim if you feel that you did not receive the coverage you have. You may be able to do this even if the urgent care clinic is not enrolled in Medicare to provide care.

Original Medicare May Not Be Enough

One of the most important things a trip to the urgent care may show you is that just having Original Medicare is not enough. It leaves you exposed to paying a significant amount of out-of-pocket expenses even when you do not visit the emergency room.

That is why it is beneficial to consider a Medigap plan. It works to fill in the costs associated with your Original Medicare. For example, if you enroll in Medicare Plan F, that may help you to have zero out of pocket costs for your visit to an urgent care. Plan N will eliminate your need to pay a copay for the visit.

What Type of Care Should I Go to the Urgent Care For?

If you are facing a life-threatening health condition, visit the emergency room. Typically, you should go to an urgent care if you are facing any of the following conditions: