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 ($198 per year in 2020), 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 most Medicare Advantage plans also include prescription drug coverage.

Some Medicare Advantage plans may also offer:

• Routine dental coverage
• Routine vision coverage
• Routine hearing coverage
• Health and wellness program benefits, such as SilverSneakers

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.

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!