Does Medicare Cover Federally Qualified Health Center (FQHC) Services?
Medicare covers federally qualified health center (FQHC) services that are considered medically necessary at specific locations. Medicare Part B covers 80 percent of the cost of any services, leaving you to pay 20 percent. There is no deductible. Also, all preventive services are free.
Medicare Coverage for Federally Qualified Health Center Services
Federally qualified health centers (FQHCs) and the services provided are covered under Medicare – specifically Medicare Part B.
An FQHC can offer a variety of outpatient and primary care and, like most treatments and services available through Original Medicare, is covered if deemed a medical necessity.
Covered visits must be face-to-face and take place with an FQHC practitioner.
- Assisted living facility
- Skilled nursing facility
- Scene of an accident
Medicare will not cover your FQHC visits if they occur at an inpatient or outpatient hospital department or a facility that excludes those types of services.
Medicaid beneficiaries should also be eligible to receive treatment and services at FQHCs.
Medicaid is an assistance program designed to help you receive healthcare coverage if you meet certain requirements, like having a low income.
Federally qualified health centers are also covered through Medicare Part C.
Expected Costs for Federally Qualified Health Center Services
Medicare Part B pays for 80 percent of the cost of any services you receive at a center – which means you are responsible for the remaining 20 percent.
You do not have to pay a deductible or coinsurance.
Preventive services are also available through an FQHC at no cost to you. Additionally, there are discounts available if your income is limited.
Where Can You Find an FQHC?
Federally qualified health centers are in rural and urban areas. These centers are meant to help underserved communities and populations as a low-cost way to receive healthcare.
According to 2018 United States National Library of Medicine study, the number of FQHCs has increased by more than 80 percent through the previous decade.
Your FQHC care options range from physician services, transitional care and chronic care management.
If you have diabetes or renal disease, you may also be eligible for outpatient diabetes self-management training and medical nutrition therapy through an FQHC. Check with your healthcare provider or local health center to determine what other services might be available to you.
- Community health centers
- Healthcare-for-the-homeless centers
- Migrant health centers
- Public housing primary care centers
The U.S. Health Resources and Services Administration offers a map to easily locate FQHCs near where you live.
9 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2021, April 26). Medicare Benefit Policy Manual. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf
- U.S. Centers for Medicare & Medicaid Services. (2021, January). Federally Qualified Health Center. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/fqhcfactsheet.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, April 9). Federally Qualified Health Centers (FQHC) Center. Retrieved from https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center
- U.S. Health Resources & Services Administration. (2018, November). What is a Health Center? Retrieved from https://bphc.hrsa.gov/about/what-is-a-health-center/index.html
- U.S. National Library of Medicine. (2018, October 23). Geographic Expansion of Federally Qualified Health Centers 2007-2014. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478577/
- U.S. Health Resources & Services Administration. (2018, May). Federally Qualified Health Centers. Retrieved from https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html
- U.S. Centers for Disease Control & Prevention. (n.d.). Medicaid Service Delivery: Federally Qualified Health Centers. Retrieved from https://www.cdc.gov/phlp/docs/brief-fqhc.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Federally Qualified Health Center (FQHC) services. Retrieved from https://www.medicare.gov/coverage/federally-qualified-health-center-fqhc-services
- U.S. Health Resources & Services Administration. (n.d.). Find a Health Center. Retrieved from https://findahealthcenter.hrsa.gov/