Medicare Coverage of Urgent Care Centers
Emergency care is for life-threatening injuries or illnesses that put you in serious danger. If something has happened to you that could cause great bodily harm or even be fatal, then a trip to an ER is necessary.
Urgent care on the other hand, is for less threatening injuries. Say it’s Saturday night and you cut yourself while preparing dinner. If the cut is deep and you need stitches, a visit to an urgent care clinic is likely to provide the care you need at a; significantly lower copay than an ER visit. More importantly, a visit to an urgent care clinic will often take less time, as these clinics are not dealing with the more life threatening types of injuries that a hospital does.
Many urgent care centers accept Medicare readily, and there are new locations opening in major cities all the time. You have probably seen local urgent care centers in your town or the town nearest to you. Often these clinics are open until late at night, and on Saturdays. Some clinics even have 24-hour and Sunday hours.
Urgent care clinics are staffed by medical doctors, physician’s assistants and nurses, just like any ordinary doctor office that you visit. A wide range of services and diagnostic tests are available. What’s great is that they can help with minor bumps and bruises as well as things like migraines, sinusitis, urinary tract infections and all sorts of other ailments.
So next time you find yourself with an emergency, consider whether it is minor enough to visit just an urgent care clinic instead of spending long hours waiting in an emergency room. It’s a great alternative and can help reduce some of your out of pocket costs as well.
Urgent Care Centers Vary
While most urgent care centers will accept Medicare unconditionally, there are a few locations that will choose not to do business with Medicare-covered patients. These locations are rare, and are very open about this policy. In some cases there will be urgent care centers that have doctors who do treat Medicare-covered patients, as well as doctors who will not see Medicare-covered patients. The centers will explain this to you if you should encounter it.
While Medicare does cover urgent care, urgent care centers each have the right to accept or deny any insurance provider. However, it is rare to find a center that does not accept Medicare insurance.
Some physicians have chosen to opt-out of Medicare, and refuse to treat patients with this insurance. They require Medicare patients to sign a private contract stating that the patient may not file claims with Medicare for services rendered. However, according to federal regulation 40.28, which went into effect in January of 2013, patients’ at urgent care facilities may be treated by these opt-out physicians. The physicians are subject to additional paperwork, but the patient will not experience issues.
Medicare-covered patients who find Medicare-accepting doctors will pay less and experience less hassle filing claims. These doctors have agreed to pre-determined fee schedules, so there is no discrepancy for filing claims.
Patients with Medicare can rest assured that there are facilities that accept their insurance. By being prepared with the facts beforehand, your office visits will go more smoothly and you will enjoy greater peace of mind.
Medicare Part B (Medical Insurance) typically covers most urgent care. There are out-of-pocket costs that you will likely have to pay for these benefits, however.
Urgent Care Locations vs. Emergency Room Care
Both urgent and emergency room care; are covered by Medicare Part B as outpatient care. However, there are several advantages to receiving care at an urgent care center rather than a hospital ER. A visit to the urgent care clinic can often mean:
- Lower costs
- Shorter wait time
Urgent care centers are typically staffed by physicians, physician’s assistants and nurses, just like any other doctor’s office or ER - the difference is that they aren’t equipped to treat life-threatening injuries or illnesses. As long as your injury or illness is non life-threatening, a visit to the urgent care clinic may save you money and time.
Medicare Part A does not cover urgent care clinic visits, but it will help cover some of the costs of inpatient hospital care, lab tests, surgeries and some other costs.
How Does Medicare Pay for Urgent Care Location Visits?
As long as the urgent care center you go to participates in Medicare, your Medicare insurance will typically cover 80 percent of the Medicare-approved cost for services, and you’ll pay the remaining 20 percent coinsurance after you have met your Medicare Part B deductible
A Medicare Supplement Insurance plan (also called Medigap) can help cover some of your out-of-pocket Medicare costs such as deductibles and coinsurance. There are up to 10 standardized Medicare Supplement Insurance plans available in most states, so it helps to explore your options to find a plan that fits your needs. Give us a call to learn more about your Medicare Supplement options today.