It is important to get immediate care in emergency cases. However, urgent care facilities often have high costs for receiving the care.
But if you need to get immediate care at a facility like this, a lot of people want to know “does Medicare cover immediate care?” In this article, we answer that question in clear, plain English. You will also find the average costs of immediate care and other helpful info.
Does Medicare Cover Immediate Care?
The short answer is yes. Medicare will cover the cost of immediate care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your immediate care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for urgent care. Parts A and/or B provide coverage for your immediate care if it is considered medically necessary.
Coverage for urgent care is provided by Medicare Part B as it takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of emergency care. You will pay for the remaining 20 percent.
For Medicare beneficiaries who are traveling outside of the United States and get sick or injured, a Medigap plan may help you in providing coverage for the cost of your urgent care visit. Medigap will pay for 80% of the cost of medically necessary emergency treatment.
However, at an urgent care center or a healthcare provider that does not participate in Medicare you will pay for 100% of the cost upfront, and you may file a reimbursement claim with Medicare. To file a reimbursement claim, you will need to submit the following:
- A receipt of your urgent care visit
- A letter explaining that the urgent care center does not accept Medicare
- Claim form from Medicare
Original Medicare also provides coverage for emergency room expenses. Coverage for emergency care is provided by Medicare Part A if it takes place in an inpatient setting.
Part C Coverage for Immediate Care
Medicare Advantage plans (Medicare Part C) also provide coverage for immediate care. They have to cover everything Original Medicare covers but will offer some additional benefits as well. What these benefits are and how much your out-of-pocket costs will be vary depending on the specifics of your plan.
How Much Does Immediate Care Cost?
The average urgent care visit may cost between $100 to $150. Emergency room visits usually range between $150 to $3,000, or even more. It can even reach up to $20,000 or more if the condition being treated is more critical.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare Cover Cortisone Injections?