Does Medicare Urgent Care?
Medicare covers urgent care and certain other medically necessary treatments you may receive at an urgent care center. Learn more about Medicare outpatient coverage and emergency care benefits.
Medicare Part B and Medicare Advantage plans cover urgent care for medically necessary treatment. It's important to understand Medicare urgent care coverage if beneficiaries are faced with sudden illness or injury.
In this guide, we will explore the different aspects of Medicare coverage for urgent care services, and we'll highlight ways you may be able to maximize your Medicare coverage if Medicare Advantage (Medicare Part C) plans are available from private insurance companies where you live that pay for extra health care benefits.
When Does Medicare Pay for Urgent Care in Medical Emergencies?
In most cases, Medicare Part B covers medically necessary urgent care services for injuries, sudden illness or other health concerns.
This means that if you have Original Medicare (Part A and Part B) or a Medicare Advantage (Part C) plan, your urgent care visit should be covered as long as the provider accepts Medicare assignment.
- You may still need to pay a deductible before your coverage kicks in. For example, with Medicare Part B, there is an annual deductible amount you must meet before receiving benefits. Medicare Advantage plan deductibles may vary, as they are sold by private insurance companies.
- Copayments also apply after meeting the deductible, and the costs may vary depending on what types of emergency services you receive.
In the event of a medical emergency, it's important to seek urgent care services immediately. Medicare covers emergency room services, which means you can receive care at any hospital that accepts Medicare.
If you receive emergency room emergency services from a hospital that is not Medicare-approved, you may be responsible for the full cost of the visit.
What Urgent Care Isn't Covered by Medicare?
While Medicare covers many emergency department services, there are some exceptions. For example, if you receive care at an urgent care clinic that is not Medicare-approved and isn't covered, you may be responsible for the full cost of the visit.
Additionally, Original Medicare does not cover prescription drug coverage, so any medications prescribed during your visit may not be covered.
Understand Medicare coverage before you seek urgent care services. Knowing what services are covered by Medicare and how to determine eligibility can help ensure that you receive the care you need.
Call to speak with a licensed insurance agent who can answer your Medicare questions and help you compare Medicare Advantage plans where you live, including what they cost, the doctors they cover and the benefits that may be available.