Medicare provides coverage for treatment needed at an urgent care facility. These facilities offer treatment for significant injuries or illnesses that are not life-threatening.
Urgent care centers offer timely, affordable, and professional health care for people with non-life-threatening complaints, making them an excellent alternative to hospital emergency rooms and medical clinics.
People visiting urgent care centers for the first time may wonder whether Medicare covers their treatment. Read on to learn more about how Medicare helps people in the United States access urgent care.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Urgent care is a type of walk-in medical clinic that treats illnesses and injuries that are significant, but not life-threatening. These health problems are serious enough that treatment should not wait until the following day. Since urgent care centers have extended hours, people can visit them when they cannot see their primary care physician.
Some of the illnesses and injuries that urgent care centers treat include:
- low-grade fevers
- deep cuts without serious blood loss
- falls and other accidents requiring urgent care
- broken or fractured bones
- sprained joints
- persistent vomiting or diarrhea
The doctors and nurses at urgent care centers can also perform diagnostic tests and minor medical procedures. These include:
- blood tests
Urgent care centers provide timely care. According to the 2019 Urgent care association report, 97% of people attending urgent care centers see a health care provider within 60 minutes, and 92% see a provider within 30 minutes.
In contrast, 73.3% of people attending emergency rooms see a health care provider within 60 minutes, based on the
Medicare Part B is a component of original Medicare. It is available to anyone with original Medicare, or as part of a bundled Medicare Advantage plan, and covers essential medical services and supplies. These services and supplies include:
- preventive services
- outpatient care
- emergency services
- clinical research
- ambulance services
- durable medical equipment
- home health care
- mental health services
- rehabilitative services
- limited outpatient prescription medications
Medicare Part B may also cover doctor-recommended physical therapy following an accident or fall.
Medicare Part B covers urgently needed care, as treatment received from urgent care centers falls under outpatient care.
Qualifying services help people with injuries, sudden illnesses, or health conditions that deteriorate rapidly.
Urgent care facilities accepting Medicare
Most urgent care centers accept Medicare. However, urgent care centers can choose to accept or deny any health insurance, including Medicare.
The facility a person visits will confirm whether or not they accept Medicare, but even if they do not, this does not mean they will not provide the necessary care.
Urgent care centers must treat an individual with Medicare, even if they do not accept the coverage, and these centers will typically require full payment up-front. Medicare will then reimburse a person for the amount paid after receiving paperwork from the non-participating urgent care center.
Some Medicare-participating urgent care centers employ doctors who have opted out of Medicare. According to the Medicare Benefit Policy Manual, these physicians must treat people with Medicare needing urgent care.
Opt-out physicians must complete additional paperwork, and a person they treat will only pay the cost over the Medicare-approved amount, known as an excess charge.
In 2020, the Medicare Part B deductible cost is $198. The deductible may change every year. The Centers for Medicare and Medicaid Services (CMS) list the most recent cost and the reason for any changes.
Medicare Part B covers 80% of eligible costs for urgent care. After a person has paid the deductible in full, they must settle the remaining 20% coinsurance themselves.
The specific out-of-pocket cost for urgent care varies based on several factors, including:
- if a person has paid their full deductible
- if a person has other health insurance
- the type of urgent care services required
- how much the urgent care facility charges
Medicare Part B covers limited prescription medications, and a person must usually pay out-of-pocket for any drugs their urgent care physician prescribes.
Medicare Part D and some Medicare Advantage plans do provide coverage for prescribed medication, so a person with either of these plans will typically pay less for their prescribed drugs.
People visiting urgent care facilities require medical treatment fast, whether they can afford it or not. Urgent care centers understand this, so often have finance options for people who cannot cover their out-of-pocket costs. These options include payment plans, often without interest, and discounted services.
Individuals with limited resources should speak to an urgent care representative about their payment options.
A Medicare supplement insurance (Medigap) policy can also reduce the out-of-pocket costs of urgent care.
Medicare supplement insurance can help pay the 20% Part B coinsurance. Some Medigap policies purchased before January 1, 2020, also cover the Part B deductible.
Medicare Part B helps people receive affordable urgent care treatment across the country. Most urgent care centers participate in the Medicare program.
Medicare Part B covers 80% of treatment costs at these facilities, which means individuals have relatively small out-of-pocket costs.
Urgent care centers can also help people who cannot easily afford the out-of-pocket fees. Low, flexible payments and high Medicare participation rates help ensure that people with Medicare can access urgent care.