Medicare Part B provides coverage for treatment needed at an urgent care facility. These facilities offer treatment for significant injuries or illnesses that are not life threatening.
Urgent care centers offer timely, affordable, and professional healthcare for people with non-life-threatening complaints, making them an excellent alternative to hospital emergency rooms and medical clinics.
As part of Original Medicare, Medicare Part B covers urgent treatment for a sudden illness or injury that isn’t a medical emergency.
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Urgent care is a type of walk-in medical clinic that treats significant but not life threatening illnesses and injuries. These health concerns are serious enough that a person should not wait until the following day for treatment.
Original Medicare covers urgent care under Medicare Part B, as treatment received from urgent care centers falls under outpatient care.
Qualifying services help people with injuries, sudden illnesses, or health conditions that deteriorate rapidly. Since urgent care centers have extended hours, people can visit them when they cannot see their primary care physician.
Some of the illnesses and injuries that urgent care centers treat include:
- low grade fevers
- deep cuts without serious blood loss
- falls and other accidents requiring urgent care
- broken or fractured bones
- sprained joints
- persistent vomiting or diarrhea
The doctors and nurses at urgent care centers can also perform diagnostic tests and minor medical procedures. These include:
- blood tests
- X-rays
- stitches
Medicare Advantage (Part C) is a Medicare-approved plan from a private company that sets its own cost and coverage amounts. Therefore, deductibles, coinsurance, and premium amounts depend on the chosen plan.
Generally, these plans have a set amount to pay for an urgent care visit. For specific information, it is best to consult the plan provider.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare doesn’t usually cover healthcare for those traveling outside the United States.
However, some Medicare supplement insurance (Medigap) plans can help cover the costs of medical treatment when traveling abroad.
Medigap is extra insurance from a private company to help cover the costs of Original Medicare.
Most Medigap plans will cover emergency services for the first 60 days a person is out of the United States. After the person pays a deductible, Medigap will cover 80% of the cost of medically necessary emergency treatments.
In 2024, the Medicare Part B premium costs $174.70 each month or more, depending on a person’s income.
The Part B yearly deductible is $240. The deductible may change every year.
Medicare Part B covers 80% of eligible costs for urgent care. After a person has paid the deductible in full, they must settle the remaining 20% coinsurance themselves.
The specific out-of-pocket cost for urgent care varies based on several factors, including:
- whether a person has paid their full deductible
- whether a person has other health insurance
- the type of urgent care services required
- how much the urgent care facility charges
Medicare Part B covers limited prescription medications, and a person must usually pay out of pocket for any drugs their urgent care physician prescribes.
Medicare Part D and some Medicare Advantage plans do provide coverage for prescribed medications, so a person with either of these plans will typically pay less for their prescribed drugs.
People visiting urgent care facilities require medical treatment fast, whether they can afford it or not. Urgent care centers understand this and often offer finance options for people who cannot cover their out-of-pocket costs. These options include payment plans, often without interest, and discounted services.
Individuals with limited resources should speak with an urgent care representative about their payment options.
A Medicare supplement insurance (Medigap) policy can also reduce the out-of-pocket costs of urgent care and help pay the 20% Part B coinsurance.
Most urgent care centers accept Medicare. However, they can choose to accept or deny any health insurance, including Medicare.
The facility a person visits will confirm whether or not it accepts Medicare. If it does not, this does not mean it will not provide the necessary care.
Urgent care centers must treat an individual with Medicare, even if they do not accept the coverage, and these centers will typically require full payment up front.
Medicare will then reimburse a person for the amount paid after receiving paperwork from the nonparticipating urgent care center. A person will need to file a reimbursement claim with Medicare.
Medicare Part B helps people receive affordable urgent care treatment across the country. Most urgent care centers participate in the Medicare program.
Medicare Part B covers 80% of treatment costs at these facilities, which means individuals have relatively small out-of-pocket costs.
Urgent care centers can also help people who cannot easily afford the out-of-pocket fees. Low, flexible payments and high Medicare participation rates help ensure that people with Medicare can access urgent care.