Does Medicare Cover Urgent Care Visits?
And learn the distinction between urgent care and emergency room visits.
Does Medicare Cover Urgent Care Visits?
Yes, Medicare covers your urgent care visits. Specifically, it is Medicare Part B that will cover urgently needed care to treat sudden illness or injury that is not considered a medical emergency.
In the case of an urgent care visit, you will pay 20% of the Medicare-approved amount for your doctor or healthcare provider services (while Medicare covers the other 80%).
However, keep in mind that the Part B deductible does apply here.
Also, note that if you are in a hospital outpatient setting, you will also have to pay a copayment to the hospital.
Understanding Urgent Care vs. Emergency Room Visits
For starters, both urgent care visits and emergency room visits are covered by your Medicare Part B coverage.
While there is a distinction between the two, urgent care generally falls under the umbrella of emergency department services as defined by Medicare.
Even though the two are related in this way and are covered by Part B, there are a few important distinctions you will want to be aware of.
These distinctions relate specifically to the advantages of an urgent care visit compared to that of an emergency room visit. Generally, a visit to an urgent care clinic can help you save on both cost and wait time.
Most urgent care centers are staffed the same as any doctor’s office or emergency room. The key difference here is that urgent care centers are not equipped to treat injury or illness that is life-threatening.
So, if this does not apply to you, you might want to consider an urgent care clinic.
Important! Only take this into consideration if your injury or illness is not life-threatening. If you are suffering from a life-threatening injury or illness, immediately go to the ER.
Costs for Your Urgent Care Visit
So long as you visit an urgent care clinic that participates in Medicare, your Original Medicare coverage (in this case Part B) will cover 80% of the Medicare-approved amount for your services.
Once Medicare covers their portion, you are responsible for the remaining 20%.
Keep in mind that the Medicare Part B deductible applies here. The Part B deductible for 2020 is $198. So, you are responsible for the first $198 in costs before your Part B coverage kicks in and begins covering 80% of the costs.
What Does Medicare Part B Cover?
When you sign up for Medicare Part B, you receive coverage for both medically necessary services and preventive services.
This includes some of the more expensive services you might experience during a hospital stay, procedures like surgery, radiation, diagnostic imaging, chemotherapy, dialysis, among others.
Part B covers preventive medical services like ambulance rides, doctor visits, screenings, and diagnostic tests. It also covers a number of preventive care measures such as flu shots, colonoscopies, and mammograms.
Medically Necessary Services:
Medically necessary services and supplies are those used for diagnosis and treatment of medical conditions.
These services and supplies must meet the accepted standards of medical practice. This includes the use of medical equipment like wheelchairs, hospital beds, and oxygen equipment.
Preventive Services:
Preventive services are those that prevent illness or detect it early enough for optimal treatment.
This includes diagnostic tests like MRIs, EKGs, CT scans, and X-rays. It also applies to covered screenings such as pap tests, HIV screening, glaucoma tests, hearing tests, diabetes screening, and colorectal cancer screenings.
If your healthcare provider accepts assignment, you often don’t have to pay anything for these preventive services.
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