Does Urgent Care Take Medicare? 

The short answer is yes, many urgent care centers do accept Medicare. But coverage depends on your plan type and whether the provider is Medicare-approved. Most urgent care clinics that treat adults are registered with Medicare and will bill Medicare Part B for outpatient services. However, it’s essential to verify with the clinic before your visit to avoid surprise bills.

When you’re not feeling well and your primary doctor is unavailable, urgent care clinics can be a lifesaver. They offer fast treatment for non-life-threatening conditions like sprains, infections, or minor cuts. But if you’re a Medicare beneficiary, one question likely pops into your head before stepping into the clinic: Does urgent care take Medicare? This guide provides everything you need to know about Medicare coverage and urgent care services, so you’re never left guessing when you need help the most.

What does Medicare cover when it comes to urgent care visits?

Medicare typically covers urgent care under Part B, which includes medically necessary outpatient services. This means if you go to an urgent care center for something that’s not a medical emergency but needs attention within 24 hours, such as a urinary tract infection, flu symptoms, or minor injuries, you’re generally covered.

Medicare will spend 80% of the approved cost, while you’re responsible for the remaining 20%, after your Part B deductible is met.

Does Original Medicare provide coverage for urgent care services?

Yes, Original Medicare (Parts A and B) provides coverage for urgent care services under Part B. So, if you’re enrolled in Original Medicare, you don’t need a referral to access an urgent care clinic. The key is making sure that the urgent care provider participates in Medicare and agrees to accept the Medicare-approved amount.

What is considered urgent care, and how is it different from emergency care?

This distinction matters.

• Urgent care addresses medical issues that require prompt treatment but are not life-threatening, such as minor infections, earaches, or sprained ankles.
• Emergency care is for conditions that could be life-threatening or cause permanent harm if not treated instantly, such as chest pain, shortness of breath, or head trauma.

Going to urgent care for non-emergencies can help you save both time and money, especially since emergency rooms typically cost much more and have longer wait times.

Do urgent care facilities generally accept Medicare?

Most urgent care clinics do accept Medicare, but not all. It’s crucial to call ahead or check online to see if a particular facility is Medicare-approved. Clinics that accept Medicare will typically bill Medicare directly, and you’ll only be responsible for your portion of the cost (usually 20% after the deductible).

Additionally, some walk-in retail clinics may fall under the sort of urgent care. Still, they may or may not bill Medicare. Always confirm first.

What specific urgent care services are covered by Medicare?

Under Medicare Part B, the following services are typically covered at urgent care centers:

• Diagnostic tests (e.g., flu or COVID tests)
• X-rays
• Wound care and stitches
• Treatments for minor illnesses (like colds, infections, or fevers)
• Medications administered in the clinic
• Basic lab work
• Some preventive care, depending on your condition

However, prescriptions filled at a pharmacy afterward are not covered by Part B. For that, you’ll need Part D or a Medicare Advantage plan with drug coverage.

How can I find an urgent care clinic that accepts Medicare patients?

There are a few ways to find Medicare-approved urgent care clinics:

1. Medicare.gov’s Physician Compare Tool: You can search for urgent care providers in your zip code who accept Medicare.
2. Call the urgent care clinic and ask if they accept Medicare and if they’re participating providers.
3. If you’re enrolled in a Medicare Advantage plan, use your plan’s provider directory to find in-network urgent care centers.

What is the cost of visiting urgent care under Medicare Part B?

Under Medicare Part B, you generally pay:

• 20% of the Medicare-approved amount for the services you receive
• The annual Part B deductible (which is $240 in 2024)

For example, if your visit costs $150 and you’ve already met your deductible, you’d pay around $30. Keep in mind: if the urgent care facility charges more than the Medicare-approved rate or is not a participating provider, you may owe more.

Does Medigap cover additional urgent care costs not paid by Medicare?

Yes, if you have a Medigap (Medicare Supplement Insurance) policy, it can cover some or all of the out-of-pocket costs not paid by Medicare Part B. That means:

• The 20% coinsurance after Medicare pays its share
• The Part B deductible, depending on the Medigap plan

For frequent travelers or those who want peace of mind when using urgent care services, Medigap can be a valuable safety net.

How does Medicare reimbursement work for urgent care services?

If the urgent care clinic is a Medicare-participating provider, it will submit your claim directly to Medicare. Medicare will:

1. Approve the covered amount
2. Pay 80% of the cost directly to the provider
3. Send a Medicare Summary Notice (MSN) to you
4. Leave you responsible for the remaining 20%, which may be paid by you or your Medigap insurer

If you’re using a non-participating clinic, they may require you to pay the full amount up front.

Then you’ll need to file a reimbursement claim with Medicare yourself.

What should Medicare beneficiaries know when seeking urgent care while traveling domestically or abroad?

If you’re traveling within the U.S., you can visit any urgent care clinic that accepts Medicare, regardless of your home state. This is particularly helpful for snowbirds or retirees exploring the country. 

International travel is a bit trickier. Original Medicare generally does not cover medical care outside the U.S., except in minimal circumstances. However:

• Some Medigap plans (C, D, F, G, M, N) offer limited foreign travel emergency coverage
• Some Medicare Advantage plans may provide worldwide coverage, but check your plan details

When traveling abroad, consider purchasing travel medical insurance for added peace of mind.

Does Medicare Advantage offer better or broader urgent care coverage than Original Medicare?

Yes, many Medicare Advantage (Part C) plans offer expanded urgent care coverage, including:

• Lower copays for urgent care visits
• Coverage for telehealth urgent care
• Entry to a wider network of providers
• Prescription drug coverage bundled in

Some Medicare Advantage plans even include international urgent care coverage, making them a better choice for frequent travelers. Be sure to use in-network providers whenever practicable to minimize costs.

Final Thoughts

Does urgent care accept Medicare? In most cases, yes. Whether you have Original Medicare or a Medicare Advantage plan, you’re generally covered for urgent care visits, as long as the provider accepts Medicare. Still, it’s wise to confirm the clinic’s status before your visit and understand what costs you may be responsible for.

Medicare helps make urgent care more affordable, accessible, and straightforward for millions of Americans. Whether you’re at home or traveling, knowing your coverage ahead of time gives you the confidence and peace of mind you need when unexpected health concerns arise.

Need help finding a Medicare-friendly urgent care provider in your area? Use medicare.gov or call your plan’s support line to get started.

Disclaimer: This article is for informational purposes only. Medicare coverage and costs can vary by region, plan type, and individual circumstances. Always speak directly with your provider or Medicare representative for the most accurate information.

Source: healthcare.gov