Do Urgent Care Centers Accept Medicare?

Urgent care centers serve as a convenient option for addressing non-life-threatening conditions that require prompt medical attention but are not severe enough for an emergency room visit. These facilities bridge the gap between a primary care physician’s office and a hospital emergency department. Medicare generally covers services received at urgent care centers, providing beneficiaries with access to timely care.

Medicare Coverage for Urgent Care Services

Most urgent care centers across the United States accept Medicare and are Medicare-approved, which is important for coverage. Urgent care centers treat a range of conditions such as colds, flu, minor cuts, sprains, infections, and allergic reactions. They can also perform diagnostic tests like X-rays and lab work related to the visit.

Medicare Part B, medical insurance, is the primary coverage for urgent care services. It covers medically necessary outpatient services and supplies, including doctor’s visits at an urgent care facility. If you have Original Medicare, Part B covers treatment for sudden illnesses or injuries that are not medical emergencies.

Medicare Advantage Plans, also known as Medicare Part C, are offered by private companies approved by Medicare and must provide at least the same coverage as Original Medicare Parts A and B. These plans also cover urgent care services, though the specific rules can vary. Many Medicare Advantage plans operate with specific provider networks, meaning beneficiaries might need to use in-network urgent care centers for the lowest costs.

Medicare Part A, which primarily covers hospital insurance, does not cover urgent care visits unless the visit leads to an inpatient hospital stay. Outpatient services received at an urgent care center fall under Medicare Part B or a Medicare Advantage Plan. Urgent care centers are distinct from emergency rooms and primary care physicians, who handle routine check-ups.

Understanding Your Costs for Urgent Care

Out-of-pocket costs for urgent care vary depending on your Medicare plan. For Original Medicare Part B, an annual deductible must be met before Medicare begins to pay. In 2025, this Part B deductible is $257. After the deductible is satisfied, beneficiaries pay a 20% coinsurance of the Medicare-approved amount for most doctor’s services, including those provided at an urgent care center.

It is important for the urgent care center to accept “assignment,” meaning they agree to accept the Medicare-approved amount as full payment for services. If a provider does not accept assignment, they may charge up to 15% more than the Medicare-approved amount, and you might be responsible for the difference. In such cases, you may have to pay the full bill upfront and then seek reimbursement from Medicare.

For those enrolled in a Medicare Advantage (Part C) plan, costs for urgent care visits differ among plans. Medicare Advantage plans often charge a fixed copayment for an urgent care visit, which is typically lower than the copayment for an emergency room visit. Beneficiaries should consult their specific plan’s Summary of Benefits or contact their plan provider to understand their exact financial responsibilities.

Medicare Supplement Insurance, also known as Medigap, can help cover some of the out-of-pocket costs associated with Original Medicare. These policies can assist with expenses like the Part B deductible and the 20% coinsurance. Medigap plans are offered by private companies and can help reduce the financial burden of urgent care visits.

Ensuring Smooth Urgent Care Visits with Medicare

Before visiting an urgent care center, call ahead to confirm they accept Medicare and are accepting new Medicare patients. Have your Medicare card readily available, along with any other insurance cards like Medigap or Medicare Advantage plan cards, to streamline check-in. Bringing a current list of your medications and relevant medical history can also help providers offer appropriate care.

During your visit, ensure the urgent care center intends to bill Medicare directly for services. If you have questions about potential costs, ask the staff for clarification before receiving treatment. Urgent care centers collect copayments or coinsurance at the time of service, so be prepared.

After your visit, you will receive an Explanation of Benefits (EOB) from Medicare, which details what services were billed, what Medicare paid, and what amount you may owe. It is important to review this document carefully and compare it with the bill from the urgent care center to ensure accuracy. If there are discrepancies or if a service is unexpectedly not covered, contact the urgent care center’s billing department, Medicare, or your Medicare Advantage plan for clarification and resolution.