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- Published: June 22, 2021
- Updated: October 20, 2023
- 4 min read time
- This page features 8 Cited Research ArticlesUrgent Care Coverage at a Glance
Medicare Plan Urgent Care Coverage Part A (Inpatient) N/A Part B (Outpatient) Covers 80% of urgent care visit services and tests after you have reached your Part B deductible. You will also owe copayments for each service received. Part C (Medicare Advantage) Costs for urgent care visits vary by plan. Part D (Prescription Drugs) Yes Supplemental Insurance Can help cover out-of-pocket costs related to urgent care visits. Coverage varies by plan.
Medicare Coverage for Urgent Care Visits
Urgent care visits offer access to immediate medical attention for unexpected injuries or illnesses. Medicare will cover these visits and any treatment or procedures you receive during your visit under Part B.Common Injuries or Conditions Worth an Urgent Care Visit
- Bleeding from a cut
- Minor broken bones or fractures
- Urinary tract infections
- Vomiting or diarrhea
Urgent care clinics also offer other Medicare-covered services outside of immediate illness and injury. For example, you can receive annual physicals and X-rays at clinics, as well as vaccine and immunization shots.
Remember, an urgent care visit is for minor, unexpected medical conditions. Anything more serious would require a trip to the emergency room.
Medicare also covers emergency department services for these situations.Have you selected your 2024 Medicare plan?Maximize your Medicare savings by connecting with a licensed insurance agent. Annual Enrollment is open until December 7th.
Expected Costs of Urgent Care Visits
If you have Original Medicare — Part A and B, collectively — then 80% of the cost for treatment and services received at an urgent care clinic will be covered.
With Part B, you will have to meet a deductible before coverage begins. After the deductible has been met, you pay 20% of the Medicare-approved cost.
You will also have to pay a copayment if you receive care in a hospital outpatient setting.
Urgent care visits are also covered through a Medicare Advantage plan since they include everything covered in Original Medicare.
Medicare Advantage plans also include additional benefits and coverage and what is offered in Part A and Part B.
Check with your plan provider to learn about any expanded coverage available related to urgent care trips.
As a result of your urgent care clinic, a doctor or healthcare provider may recommend a prescription drug to help you recover from your injury or illness.
Prescription drug coverage is not available through Original Medicare — but is covered by Medicare Part D as an optional benefit through private insurers.
Medicare Reimbursement for an Urgent Care Visit
As with most Part B coverage, your urgent care visit will only be covered if the clinic you visit and the doctor or healthcare provider who treats you are enrolled in Medicare.
It is important to inquire about this before you receive any services to make sure that you are covered. If not, then you will have to pay out-of-pocket for any treatment you receive.
However, you can file a Medicare reimbursement claim later to get your money back even if the clinic is not enrolled.
When filing the claim, you will need to include the bill from the doctor or clinic as well as a letter explaining your reasoning for wanting reimbursement. You can find the form to fill out here.
You must file the claim within a year of when you received the services in question.
If you have a Medicare Advantage plan, then you do not need to file a claim.3 Minute Quiz: Can You Retire Comfortably?Take our free quiz & match with a financial advisor in 3 easy steps. Tailored to your goals. Near you or online.
FAQs About Medicare's Coverage of Urgent Care VisitsHow do you filter for urgent care facilities that accept Medicare?To filter a search for urgent care facilities that accept Medicare, go to www.Medicare.gov and click the “Find Providers Near Me" button. Choose the “Doctors & Clinicians” option and fill out the “My Location” box. Under “Name & Keyword,” type in “Urgent Care.”
This will give you a list of urgent care facilities near you. Not all the providers on this list may accept Medicare. Check with them first.Will Medicare pay for me to go to the ER vs. urgent care?Medicare covers both ER visits and visits to urgent care facilities. You should only go to an emergency room if you are facing a life-threatening condition needing immediate attention. If you need medical care for a non-life-threatening illness or injury and you can’t get an immediate appointment with your doctor, consider urgent care.Does TRICARE for Life cover urgent care?TRICARE for Life covers urgent care. It defines urgent care as medically necessary care or services for an illness or injury that requires medical attention within 24 hours, but won’t result in disability or death if it doesn’t get immediate attention. If you have both TRICARE and Medicare, each may pay a portion of your urgent care services.Advertisement
Connect With a Financial Advisor InstantlyLast Modified: October 20, 2023
8 Cited Research Articles
- Tricare.mil. (2021.) TRICARE For Life Handbook. Retrieved from https://www.tricare.mil/Publications/Handbooks/tricare_for_life
- NH HealthCost. (2018, June 15). What are urgent care centers? Are they less expensive? Do I need a referral? Retrieved from https://nhhealthcost.nh.gov/guide/question/what-are-urgent-care-centers-are-they-less-expensive-do-i-need-referral
- Idaho State University. (2016, June 1). Immunization and Vaccinations Available at Urgent Care Clinics. Retrieved from https://blog.cetrain.isu.edu/blog/immunization-and-vaccinations-available-at-urgent-care-clinics
- U.S. Centers for Medicare & Medicaid Services. (2015, April 10). CMS Manual System. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R206BP.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Emergency department services. Retrieved from https://www.medicare.gov/coverage/emergency-department-services
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How do I file a claim? Retrieved from https://www.medicare.gov/claims-appeals/how-do-i-file-a-claim
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Urgently needed care. Retrieved from https://www.medicare.gov/coverage/urgently-needed-care
- Medicare.gov. (n.d.) Part B costs. Retrieved from https://www.medicare.gov/your-medicare-costs/part-b-costs
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