Does Medicare Cover Urgent Care?

Yes, Medicare Part B typically covers urgent care, as long as you visit a provider that participates in Medicare.

Once your Part B deductible is met ($185 per year in 2019), you typically pay 20 percent of the Medicare approved amount for urgent care services, and Medicare pays the remaining 80 percent.

Doctor reviews information with patient

Urgent care vs. emergency room care

Emergency room (ER) care is typically intended for life-threatening conditions that could put you in serious danger. Urgent care facilities can typically be used for minor illnesses or injuries that do not pose an immediate serious threat to your health or wellbeing.

Outpatient ER care and urgent care are both covered by Medicare Part B (medical insurance). If you visit an emergency room and are admitted to the hospital as an inpatient, your hospital stay is covered by Medicare Part A (hospital insurance).

Understanding your Original Medicare coverage

Original Medicare is made up of two parts: Medicare Part A and Medicare Part B.

Medicare Part A is hospital insurance and covers services including:

  • Inpatient care in a hospital or skilled nursing facility
  • Skilled nursing facility care
  • Hospice care
  • Limited home health care services

Medicare Part B is medical insurance and covers medically necessary and preventive services that can include (among others):

  • Clinical research
  • Doctor’s office visits
  • Ambulance services
  • Durable medical equipment
  • Mental health services
  • Getting a second opinion before surgery

Neither Medicare Part A nor Part B cover most prescription drugs or routine vision, dental, or hearing care.

Medicare Advantage plans may offer additional benefits not covered by Medicare

Medicare Advantage plans (Medicare Part C) provide the same hospital and medical benefits as Original Medicare, and many Medicare Advantage plans may also include prescription drug coverage.

Some Medicare Advantage plans may also offer:

Does Medicare Advantage cover urgent care?

By law, every Medicare Advantage plan must cover the same benefits that are offered by Original Medicare, which means Medicare Advantage plans will cover urgent care. One exception is hospice care, but you still receive coverage under Medicare Part A even if you are enrolled in a Medicare Advantage plan.

Some Medicare Advantage plans may require you to stay within a specific network of providers, though exceptions can often be made when you need emergency medical care and cannot get to a facility that is within your plan’s network.

Find a Medicare Advantage plan that covers your urgent care needs

A licensed insurance agent can help you compare Medicare Advantage plans in your area and get you enrolled in a plan that offers the benefits that fit your needs. Speak with a licensed agent today by calling TTY Users: 711, 24 hours a day, 7 days a week.

Learn more about what Medicare covers

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

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