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.
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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).
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:
Medicare Part B is medical insurance and covers medically necessary and preventive services that can include (among others):
Neither Medicare Part A nor Part B cover most prescription drugs or routine vision, dental, or hearing care.
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:
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.
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Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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