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Thinking about popping into a MinuteClinic but first want to know if Medicare will foot the bill? You’re not alone.
Good news: Medicare often does cover MinuteClinic visits. But there are some conditions you’ve got to meet first. Keep reading to find out what those conditions are, how to make sure you’re covered, and how to avoid any surprise bills.
You can find a lot more information on the treatments, services and conditions Medicare covers in our article, What Does Medicare Cover?
In this article, you’ll learn:
- The specific rules that say when Medicare will, or won’t, cover your MinuteClinic visit.
- What you might have to pay out of your own pocket.
- How to get money back if you end up paying for the visit yourself.
- Important limits and things you should be aware of before you go.
Table of Contents
Does Medicare Cover MinuteClinic Visits?
The short answer is yes. Medicare will cover the cost of minute clinics. Though 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 minute clinic appointment.
Below we look at what these are so you know what to expect.
Original Medicare Coverage of MinuteClinic Visits
Original Medicare (Medicare Part A and Part B) provides coverage for walk-in clinics such as MinuteClinic. This plan provides coverage for your walk-in clinics if considered medically necessary.
Does Part A or Part B Cover MinuteClinic?
Coverage for MinuteClinic and urgent care is provided by Medicare Part B because these facilities all work with patients on an outpatient basis.
They do not offer inpatient care. Once approved, Medicare Part B covers 80 percent of the costs of minute clinics. You will pay for the remaining 20 percent.
How to File a Reimbursement Claim
You may find that you’ll have to pay the bill for your MinuteClinic, or other urgent care, visit out-of-pocket and then file a reimbursement claim. If that’s the case, in order to file a reimbursement claim, you will need to submit the following:
- A receipt from your visit
- A letter explaining that the urgent care center does not accept Medicare
- Claim form from Medicare
Medicare Advantage Coverage of MinuteClinic Visits
Medicare Advantage plans (Medicare Part C) also provide coverage for MinuteClinic. Advantage plans are required to cover everything Original Medicare covers. But they also cover a number of treatments, services, etc. that Original Medicare does not.
Exactly what an Advantage plan covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Out-of-Pocket Costs for MinuteClinic
If you’re planning a visit to MinuteClinic, it’s good to know that they accept both Original Medicare (Part A and Part B) as well as many Medicare Advantage plans. How much you’ll end up paying out-of-pocket depends on the specifics of your Medicare coverage.
Typically, co-pays for a visit hover between $20 and $30, although this amount could vary based on your plan. If you haven’t met your yearly deductible yet, you’ll be responsible for the entire cost of the visit, minus that co-pay.
Once you’ve met your deductible, you’ll still need to cover a share of the visit’s cost, known as co-insurance, which also depends on your plan. Keep in mind that any prescription medications you get from MinuteClinic may come with an additional charge.
When compared to traditional doctor’s offices and urgent care centers, you’ll often find that MinuteClinic has lower out-of-pocket costs. This is mainly because it operates as a retail clinic, which typically has more affordable pricing.
On top of that, MinuteClinic accepts a wide range of insurance plans, including Medicare, making it more likely that you’ll have at least some coverage for your visit.
If you’re a Medicare beneficiary and want to know the exact cost of a MinuteClinic visit, it’s a good idea to reach out to your insurance company for details.
Restrictions and Limitations on MinuteClinic Visits:
It’s important to note that Medicare doesn’t cover every service offered at a MinuteClinic. For example, if you’re looking to get prescription-based services such as birth control pills or allergy medications, you’ll need to visit a Medicare-approved doctor instead.
Location is an important factor to consider when planning a visit to a MinuteClinic. They’re not available in every area, so it’s a good idea to check their website or use their app to locate one near you.
Keep in mind that the range of services can differ from one clinic to another. For instance, not all locations may offer vaccinations or X-rays. Even with Medicare coverage, you should anticipate some out-of-pocket expenses like copays or deductibles.
Additionally, it’s worth noting that MinuteClinic has limitations on the types of treatments and diagnoses they can provide. For the most accurate and comprehensive information on what is or isn’t covered, your best bet is to contact MinuteClinic or your Medicare plan directly.
The Importance of Verifying Coverage Before a Visit
Before you head to a MinuteClinic, it’s smart to double-check that your Medicare plan will cover the visit. This helps you avoid any unexpected costs.
Some Medicare plans might not cover MinuteClinic services, or the coverage could vary based on your specific plan. Plus, different services can have different out-of-pocket costs.
Here’s how to confirm your Medicare coverage for a MinuteClinic visit:
- Go online: Log into your MyMedicare.gov account to check.
- Call Medicare: Dial 1-800-MEDICARE (1-800-633-4227) for info.
- Ask MinuteClinic: When you call for an appointment, ask the staff to check your coverage for you.
Remember to always check before each visit, even if you’ve been to MinuteClinic before. Your Medicare coverage might have changed or you could be on a different plan now.
Tips for checking:
- Have your Medicare card and ID number ready.
- Make sure to specify you’re checking for MinuteClinic.
- If you’re not sure what’s covered, ask the clinic staff to help you understand your options.
By checking your Medicare coverage in advance, you’ll know what to expect and can get the care you need without stressing about the cost.
How Much Do MinuteClinic Visits Cost?
How much it costs for a visit will differ depending on the nature of your visit and how long you will be there. In some cases, you may find the cost of a visit to be either no, or very low, cost. However, it should not exceed $500.
Additional Options for Non-Covered Services
If Medicare doesn’t cover your MinuteClinic visit, there are other ways to handle payment.
Some insurance companies might pay for services that Medicare won’t, like travel vaccines. You can also shop around for cheaper healthcare providers.
Also, MinuteClinic offers self-pay discounts, so ask the staff what’s available.
When it comes to paying at MinuteClinic, you have options. You can pay the full amount right away, or go for a monthly or yearly payment plan. These plans help you break down the cost of services that aren’t covered by insurance.
There are also ways to get discounts at MinuteClinic. They have a membership program called CarePass that gives discounts and other perks like free flu shots. If you’re an AARP member, you might get discounts too.
If you’re paying out-of-pocket, remember to consider a few things. The cost can vary depending on the service. If you have a Medicare Part B deductible, you’ll need to pay that first. Even after the deductible, you might still have a copay or coinsurance.
What is MinuteClinic?
MinuteClinic is a walk-in health clinic that’s easy to find in many CVS/pharmacy stores and some Target stores. You can go there for healthcare seven days a week, even on weekends and evenings, without needing an appointment.
Brief History of MinuteClinic
Started in 2000 under the name QuickMedx, this clinic became a part of CVS in 2006 and changed its name to MinuteClinic. Nowadays, there are more than 1,100 MinuteClinic locations spread across 33 states and Washington, D.C.
Services Offered by MinuteClinic
At a MinuteClinic, you can get a lot of different health services. They can help you with common illnesses like colds or ear infections and give you preventive care like shots or yearly check-ups.
You can also go there for minor injuries like a scrape or a sprain, and they can check you for chronic conditions like high blood pressure. Women can get services like pregnancy tests, and they offer wellness services like help quitting smoking.
They even give various kinds of shots and have some extra services like travel vaccinations.
Benefits of Using MinuteClinic
MinuteClinic is easy to use because it’s in CVS and Target stores and open every day. The people who work there are qualified healthcare providers like nurse practitioners. They take most insurance and you can pay in different ways, such as with a credit card or cash.
Summing It Up
To sum it up, if you’re thinking about visiting a MinuteClinic and wondering if Medicare will cover it, you’re in luck.
Medicare often does pay for these visits, but there are a few things you need to know first. Make sure your visit is considered medically necessary, and remember, you might have to pay some costs yourself.
Don’t forget to check if your specific Medicare plan covers MinuteClinic services and what your out-of-pocket costs might be. If you have to pay yourself, you can ask for a reimbursement from Medicare.
Remember, not all services are covered, so double-check before you go. By understanding these tips and how Medicare works with MinuteClinic, you can get the care you need without worrying too much about the costs.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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?”