Medicare & Urgent Care: What's Covered as a Medicare Beneficiary?

Written by:

Aaron Garcia

Reviewed by:

Eboni Onayo

Key Takeaways

Urgent care is for illnesses or injuries not severe enough to need emergency services.
If you have Medicare, Medicare Part bMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. includes urgent care coverage.
If you have Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). , you’ll typically pay a 20% coinsuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. Your insurance company pays the remaining amount. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you’ll pay $200. Your insurance company will cover the final $800. for urgent care services if you’ve met your Part B deductible.
Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). beneficiaries often have different rates for urgent care, including flat-rate copaymentsA copayment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you’ll pay $20 to your doctor whenever you have an appointment. .

For many people on Medicare, urgent care is an important resource for staying healthy amid the illnesses and injuries that pop up. But urgent care is different from other health care in some important ways. If you’re on Original Medicare or Medicare Advantage, you’ll want to know the ins and outs of urgent care. For example: Is there such a thing as Medicare urgent care? Does Medicare cover urgent care? How can I find Medicare urgent care near me?

If you’re enrolled in Medicare, GoHealth can help you find the answers you need about urgent care and Medicare.

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Can I Go to Urgent Care if I Have Medicare?

Yes, but note the word “urgent.” Medicare defines this service as “urgently needed care to treat a sudden illness or injury that isn’t a medical emergency requiring immediate medical attention to prevent a disability or death.”[i] In other words, urgent care is for a sudden illness or injury that requires care, but treatment does not have to be received immediately to avoid death or disability.

On the flip side, an urgent care facility wouldn’t be an appropriate place to go if you need emergency care. If your injury or illness could result in death or disability, a hospital’s emergency department would probably be better equipped and staffed to meet your needs.

How much does urgent care cost with Medicare?

The answer here depends on whether you have Original Medicare (Parts A and B) or Medicare Advantage (Part C). If you’re an Original Medicare beneficiary, Part B covers urgent care visits. Part B generally pays 80% of your Medicare-approved costs once you’ve met your Part B deductible. If you’ve already paid your deductible, you’ll be responsible for paying the remaining 20% of your costs.

Many Original Medicare beneficiaries also enroll in Medigap, or Medicare Supplement Insurance, to help with these kinds of out-of-pocket costs. Medigap is a set of add-on policies that can help cover some of the costs that Part B doesn’t pay. Medigap must be purchased separately from Original Medicare and has a monthly premium.

Another option for receiving Medicare is Medicare Advantage. Medicare Advantage (Part C) replaces Original Medicare (Part A & B) but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage. It also may have different costs for services such as urgent care visits. For example, some Part C plans require beneficiaries to pay flat-rate copayments. If you have questions about Medicare Advantage and how it covers urgent care, give GoHealth a call. Our licensed insurance agents are available to break down the details and see what Medicare urgent care options you have.

How much is urgent care without insurance?

There isn’t a standard charge for urgent care; what you’ll pay if you don’t have insurance will depend on the treatment you need and how much your doctor charges. Many providers have a list of common charges for the services they offer. Uninsured patients can use these costs to estimate a budget for the care they need.

Does Medicare Cover Walk In Clinic Visit?

Walk-in clinics, like urgent care, are generally considered outpatient care. That means Medicare Part B often covers services received at a walk-in clinic. And like an urgent care visit, Part B will pay 80% for any Medicare-approved services you receive once you meet the deductible.

Before you receive any care, verify with the walk-in clinic that Medicare is accepted. If you visit the walk-in clinic and receive treatments or services before finding out it doesn’t accept Medicare, you may have to pay full price for any care you received.

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Can I Get Emergency Medicare?

Is the care you need more urgent than urgent care? Your Medicare coverage includes emergency services. You won’t need a separate policy or benefit; Parts A and B help cover a host of emergency services, including emergency transportation in an ambulance and medical care.

What Qualifies as Urgent Care?

Urgent care is appropriate for cuts that don’t require stitches, sprained joints, severe colds, or the flu, especially if they occur when your regular doctor’s office is closed. Do you need care, and you’re wondering, “Does Medicare cover urgent care?” There’s a rule of thumb to consider: Generally, urgent care is for injuries or illnesses that need attention, but they’re not severe enough to cause you to lose life or limb.

How do I find a Medicare urgent care near me?

Typically, you won’t find a Medicare-only urgent care center to visit; most standard urgent care facilities accept Medicare. To find urgent care centers around you, check online. You can also ask if your doctor is affiliated with any urgent care centers in your area. When you find an urgent care center, check to make sure it accepts Medicare before you receive care. If your urgent care facility doesn’t accept Medicare assignment, you may be stuck paying all costs out-of-pocket.

FAQs

I have Medicare Advantage and a Primary Care Physician -- do I need a referral for urgent care?

Not typically. Urgent care centers assist patients who need care but whose injuries or illnesses aren’t bad enough for the emergency room. These patients often need treatments that can’t wait for an appointment with their regular doctor, despite not being an emergency. You probably won’t need a referral in these cases, whether in a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). If you’re not sure what kind of plan you have, or to verify you don’t need a referral, call your health insurance provider.

Can I receive screenings and other preventive services at an urgent care?

With Medicare, urgent care centers offer a range of treatments and services, including some preventive services. This can include flu shots and other immunizations and vaccines. Medicare will fully cover these services. More in-depth preventive care, such as screenings, diabetes care and other services, can often be performed by an urgent care center. However, many patients benefit more by receiving this care from a primary care physician that can take a more proactive role in your health care. To recap: does urgent care take Medicare for preventive services? Often yes, but you’ll probably receive complete care by visiting your regular doctor.

If urgent care prescribes meds, are they covered by Medicare Part D?

Like your regular doctor, urgent care doctors can prescribe medications that are covered by your Part D policy. These medications need to be medically necessary and covered by your Part D plan. It’s often a good idea to communicate with your primary care physician or regular doctor when you receive a prescription from an urgent care facility. While urgent care staff can often diagnose and treat your most immediate issue, they don’t offer the in-depth care or follow-up you’ll get from your regular doctor or primary care physician. Ensure your doctor is aware of the care and medications you’ve received from an urgent care facility.

Still have questions? GoHealth has the answers you need.

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Sources

Urgently needed care. Medicare.gov.

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