When you get sick or hurt suddenly and unexpectedly, it can be difficult to know whether or not your health problem needs emergency treatment. For people who are unsure, urgent care centers exist.

Best of all, they’re usually much, much cheaper than actually visiting an emergency room. But most beneficiaries wonder: are they covered by Medicare? If you keep reading, we will answer many of your Medicare-related urgent care questions below.

Medicare and Urgent Care Facilities

Urgent care facilities are basically there to help with acute health problems which need immediate treatment but are not life-threatening. They help you feel better sooner rather than later if you come down with a sudden health problem that cannot wait for an appointment with your primary care provider.

Obviously, if you think that your health affliction is life-threatening, you should dial 911 and/or head to the nearest emergency room. But it can be difficult to know how severe your health problem is (more on that later), so it’s often a tough choice to make.

An emergency room, on the other hand, has a plethora of medical experts, equipment, and medications designed to mitigate life-threatening health problems quickly and effectively.

But this type of care isn’t cheap, as one might imagine. If you’re worried about your health care costs, going to Urgent Care first is obviously the preferred option. But if you have at least Medicare Part A, then you have hospital benefits which will protect you from most out-of-pocket expenses should you end up in the ER.

Does Urgent Care Take Medicare?

The good news is that yes, Medicare does in fact cover visits to urgent care. These services are covered under Medicare Part B because they fall under the same category as primary care doctor visits or outpatient services. But that doesn’t mean that you can get urgent care for free. There are still certain cost share expenses, co-pays, and coinsurance you will need to pay for getting that type of healthcare.

If you’re using Original Medicare by itself, you will have a 20% coinsurance fee for whatever fees they charge for service as well as the cost of the services you receive. If you have Original Medicare with a Medigap plan, Most of them will pay this coinsurance for you, but not all Medigap plans will cover 100% of your coinsurance costs.

Provided you are on Medicare Advantage, you will likely only have a modest copay with the rest of the costs being covered by your Medicare Advantage plan. But most Medicare Advantage plans are highly customized, so it’s important to talk to your insurance agent to make sure you are clear about your benefits and your financial responsibilities.

How to Know When It’s Time to Go to The ER

So how do you know when it’s time to go to the ER, and when your health problem can be more effectively solved at an urgent care center? Something like a sinus infection or a minor sprain would obviously be better dealt with at urgent care.

Conversely, something like a severe case of the flu or a break in one of your larger bones obviously needs the type of attention you can only get in an emergency room. But what if you’re not sure whether your flu is bad enough to be life-threatening? Or what if you have unexplained, acute stomach pain? It could be severe but benign indigestion — or it could be a potentially fatal case of appendicitis. It’s hard to know for sure without getting the advice of a medical professional first.

List of ailments covered at urgent care

Here’s a list of ailments that are more appropriate for an Urgent Care visit than a trip to the emergency room:

  • Sprains or minor fractures
  • Cuts or minor burns
  • A minor case of the cold or the flu
  • Animal or insect bites
  • UTIs
  • Sinus infections
  • Skin rashes
  • Strep throat

But that list is by no means a complete list. Rather, it’s a list of examples to provide context and help you make a sound decision. Conversely, if you experience any of the health problems below, you can go ahead and skip Urgent care and head straight to the ER instead:

  • Strokes
  • Seizures
  • Heart attacks
  • Severe head injuries
  • Third-degree burns (hint: first and second-degree burns are painful. If you lose feeling in the affected area, it is most likely a third-degree burn and requires emergency treatment)
  • Large broken bones
  • Uncontrolled bleeding
  • Suicidal thoughts
  • Deep gashes or other serious wounds which may require stitches or surgery

Regardless of what your particular ailment is, if you are capable of driving yourself there or asking a loved one to give you a ride, then you should probably try urgent care first.

FAQs

Is the CVS Minute Clinic Medicare-approved?

Yes, CVS Minute Clinic takes Medicare. You can also go to the CVS website in order to find your nearest MinuteClinic for the quickest and most efficient care.

What happens if I need urgent care while traveling?

Domestically, that shouldn’t be a problem. But you should call ahead and make sure the Urgent Care center that you’re going to visit accepts Medicare first.

For foreign travel, however, you’ll either need to have a Medicare Advantage plan that provides foreign travel benefits, or a Medigap plan which provides foreign travel benefits if you have Original Medicare.

How much does it cost to be seen at urgent care?

It’s hard to say an exact number because different services rendered at urgent care have their own costs. It also depends on your health care coverage.

If you have Medicare, Part B will cover 80% and you’ll pay the remaining 20%. If you have Medicare Advantage or Medigap, there’s a chance your entire visit has no charge or you might have a flat co-pay, depending on what your plan allows for.

Can I go to urgent care without insurance?

Yes, you can go to urgent care without insurance. However, you will have to pay 100 percent of the costs since there will be no coverage to help out. Having Medicare coverage though, you shouldn’t have to worry about it.

Medicare Supplement Plans To Cover You Better

Whether it’s a trip to urgent care, the doctor, or the ER, it’s imperative to make sure you have the health care coverage you need. When looking at the difference between all the additions you can make to Original Medicare, a guiding hand can ensure you make the right choice for you.

Our licensed insurance agents have extensive knowledge about all aspects of Medicare and can answer any of your questions or even explain the benefits of each plan so that you can better make your plans. The most appealing part, though, might be that the assistance from our agents is free!

Give us a call today or fill out our online rate form to be connected to the best plans in your area.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.