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Does Medicare cover urgent care?

Just the Essentials...

  • Medicare Part B does cover visits to urgent care centers, and they are treated as outpatient care.

  • Medicare Advantage plans also cover this convenient service, and may offer additional benefits.

  • There may be a Medicare Advantage plan that offers more comprehensive coverage than Original Medicare available in your area.

Are you worried about the type of coverage you’re getting from Medicare? Speak with a licensed agent at (800) 950-0608 to discover all your Medicare health insurance options.

Will Medicare pay for visits to an urgent care center?

In recent years, urgent care centers have increased in popularity, primarily because of ease of access. Often patients can walk into an urgent care clinic and see a health care provider more quickly than they could if they called their primary care physician for an appointment.

This article will explain how Medicare covers urgent care and how much you can expect to pay out of pocket when you visit an urgent care facility.

What is urgent care?

Urgent care clinics are designed to help people who need treatment for a minor emergency, or for those who need routine medical care like vaccines or blood work and lab tests. The health care providers at urgent care facilities conduct preliminary testing and examinations, prescribe medications to treat acute illness, and may be able to treat minor wounds and injuries.

Specific capabilities differ from one facility to the next, and accepted insurance plans may also vary. Even if you are planning to walk in to receive emergency care without an appointment, you may wish to call ahead and verify the center can provide the type of care you need. 

For seniors, visiting an urgent care center is an effective way to receive care that does not require hospitalization  in a timely and efficient manner.

Medicare Part B Urgent Care Coverage

The urgent care costs you pay out of pocket will largely depend on the type of Medicare plan you have. Under Medicare Part B, your yearly deductible must be met before the cost associated with your visit to an urgent care facility is covered.

Once your deductible is met, you’ll be required to pay 20% of costs related to all tests and services approved by Medicare, including those provided by urgent care centers.

Medicare Advantage and Urgent Care

Seniors enrolled in a Medicare Advantage plan will have at least the same amount of coverage for urgent care as those with Medicare Part B. They often also include additional benefits, like dental, hearing, and vision coverage.

Medicare Advantage plans are similar to traditional insurance plans, and they are provided by private insurance companies. Depending on the type of plan you choose, the deductible, coinsurance, and premiums will vary. Some may have a lower premium than Original Medicare. 

Some plans may require that the urgent care provider you use is within their network, unless there’s an emergency reason for going to an out-of-network facility. With most Medicare Advantage plans, there is typically a set amount that you will pay for urgent care visits.

 

Make sure you’re covered for the medical services you need. Call (800) 950-0608 to explore Medicare Advantage plans in your area or compare plans online.

Traveling and Urgent Care with Original Medicare

Medical emergencies can happen while you’re away from home. While Medicare Part B will generally pay for emergency care when traveling inside the United States as long as you visit a provider that accepts it, coverage outside the U.S. is extremely limited even in an emergency.

If you want coverage for urgent care outside of the country, you will need to explore other options.

How can I be sure I'm covered for urgent care when travelling?

Medigap plans are supplemental insurance plans offered by private insurance companies. They are used as a supplement to Original Medicare to help pay when Original Medicare leaves you with out-of-pocket costs. With that, many of these Medigap plans offer travel coverage, including at international urgent care facilities.

If you will be travelling outside of the country and are worried about medical emergencies, you may wish to look into Medigap coverage. Medigap travel coverage covers emergency services for the first 60 days out of the United States. Once a $250 deductible is paid, Medigap covers 80% of any treatments received, even overseas, that are considered medically necessary services.

Some Medicare Advantage plans may include coverage for urgent care received in a foreign country as well. It’s important to review your plan details.

Make sure you're covered.

Health coverage is a personal decision that isn’t easy to make. If you’re searching for the right Medicare coverage for your needs, call us at (800) 950-0608. Our team of Medicare experts can help you find the plan that will fit your needs.

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