Does Medicare Cover Urgent Care?

The popularity of urgent care facilities has surged in the United States in recent years. There are now over 10,000 of them across the country.

Urgent cares aim to fill a gap in the healthcare system between the Emergency Room and a doctor’s office visit. They help people who have injuries or illnesses that are not serious enough for a trip to the ER.

Urgent care centers are also open 7 days a week and often have evening hours. This makes them a good choice when your doctor’s office is closed.

Because they have become so popular, a common question many people have is, “Does Medicare cover Urgent Care?” In this article, we answer this question in clear, plain English. You will also find the average costs of urgent care visits, as well as other helpful info.

Does Medicare Cover Urgent Care?

The short answer is yes; Medicare will cover the cost of urgent 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 urgent care costs. 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. Coverage for urgent care falls under Medicare Part B. Just make sure you go to an urgent care facility that accepts Medicare in the first place. If they don’t, you might be on the hook for the costs (more on this in a second).

If you care is eligible for coverage, Medicare will pay for 80% of the costs that they approve for urgent care services. The other 20% is what you’ll have to pay.

Now back to a situation where visit an urgent care center that does not participate in Medicare. In this case, you will pay for 100% of the costs upfront. Afterwards, however, you may file a reimbursement claim with Medicare to get some money back. 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

Medicare Advantage plans (Medicare Part C) also provide coverage for urgent care. They cover everything Original Medicare covers as well as some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan.

How Much Does Urgent Care Visit Cost?

The average urgent care visit may cost between $100 to $150. The exact cost of urgent care treatment is determined by several factors. The main ones are what your illness/injury is and what tests and treatments you get.

What Is The Difference Between Urgent Care Visits And Emergency Room Visits?

As mentioned earlier, urgent care centers are usually for non-emergency situations and less-threatening medical conditions that need to be treated, well, urgently. Emergency rooms, on the other hand, are designed to handle life-threatening conditions that need to be treated as soon as possible.

Another notable difference between urgent care and emergency room care is that getting treatment in an urgent care center tends to be cheaper than in an emergency room. And the wait times, on average, tend to be less than at an ER.

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.