Does Medicare Cover Urgent Care?

• by Christian Worstell
• November 10, 2023
• Reviewed by John Krahnert

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 ($240 per year in 2024), you typically pay 20 percent of the Medicare approved amount for urgent care services, and Medicare pays the remaining 80 percent.

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 some Medicare Advantage plans may also offer benefits Original Medicare doesn't cover.

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.

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.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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