Does Medicare Cover Walk In Clinics?

Sometimes you don’t need to make an appointment to see a doctor, even if it’s not an emergency situation. That is exactly what walk-in clinics are for. Without ever scheduling an appointment, you can get treatment and care from a doctor.

If you are considering going to one of these places, you may have the question “does Medicare cover walk in clinics?” In this article, we answer that question in clear, plain English. You will also find the average costs you can expect to pay at a walk-in clinics.

Does Medicare Cover Walk In Clinics?

The short answer is yes; Medicare will cover the cost of walk-in clinics. 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 walk-in clinics. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for urgent care. Part B provides coverage for your walk-in clinics if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for walk-in clinics and 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 urgent care and walk-in clinics. 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, if you visit an urgent care center or a healthcare provider that does not participate in Medicare you will pay for 100% of the cost upfront. You may also 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

Part C Coverage for Walk-In Clinics

Medicare Advantage plans (Medicare Part C) also provide coverage for walk-in clinics. They must cover all the same services, treatments, etc. that Original Medicare covers. But they offer additional benefits as well. Exactly what each plan will cover and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

How Much Do Walk-in Clinics Cost?

Walk-in clinics can range from $50 to $150. This depends on the clinic as well as what services, treatment, and care are provided at the visit.

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.