Does Medicare Cover Urgent Care?

Urgent care centers provide immediate attention for illnesses and injuries that are not life-threatening but require prompt medical care. These facilities offer a convenient alternative when your primary care physician is unavailable or when a condition warrants attention sooner than a scheduled appointment.

Medicare Coverage for Urgent Care Services

Medicare Part B covers medically necessary urgent care services. This coverage is for sudden illnesses or injuries that are not medical emergencies but still require swift attention. Services typically covered in an urgent care setting include diagnosis and treatment for a range of conditions, such as colds, flu, minor cuts, sprains, infections, and mild concussions.

The coverage extends to various diagnostic services performed at the urgent care center, including laboratory tests and X-rays, provided they are medically necessary for your condition. For instance, if you have a suspected fracture, an X-ray would be covered.

“Medically necessary” means services are appropriate for diagnosing or treating your illness or injury according to accepted medical standards. Urgent care centers offer services for conditions that need prompt assessment but do not pose an immediate threat to life or limb. Most urgent care centers participate in Medicare.

Understanding Your Costs

When utilizing urgent care services under Original Medicare Part B, beneficiaries have specific financial responsibilities. After meeting the annual Part B deductible, which is $257 in 2025, you typically pay 20% of the Medicare-approved amount for urgent care services. This 20% is known as coinsurance. The specific out-of-pocket cost can vary based on factors like whether your deductible has been met and the services you receive.

In addition to coinsurance, a copayment may also apply, particularly if the urgent care is in a hospital outpatient setting. Medicare Advantage (Part C) plans handle costs differently, often featuring fixed copayments for urgent care visits rather than a percentage coinsurance. These copayments can vary by plan, so it is important to review your specific plan’s details.

Medicare Supplement Insurance (Medigap) policies can help reduce out-of-pocket expenses by covering some or all of the Part B coinsurance and deductibles. This can significantly lower your financial responsibility for urgent care. While Medigap helps with Original Medicare costs, it cannot be used with Medicare Advantage plans.

Choosing an Urgent Care Provider

Selecting an urgent care provider that accepts Medicare is a practical step to ensure coverage. Most urgent care centers accept Medicare, but it is always advisable to confirm this before receiving services. Facilities can choose to accept or deny any health insurance, including Medicare. If a facility does not accept Medicare, you may be required to pay the full cost upfront and then file a reimbursement claim with Medicare.

It is important to ask the urgent care facility about their billing practices and whether they accept Medicare assignment. When a provider accepts assignment, they agree to accept the Medicare-approved amount as full payment, which can help limit your costs. The official Medicare website, Medicare.gov, offers a “Care Compare” tool that beneficiaries can use to find Medicare-approved providers in their area.

For those enrolled in a Medicare Advantage plan, it is important to verify that the urgent care center is within your plan’s network to receive the lowest out-of-pocket costs. While Medicare Advantage plans are required to cover urgent care services, visiting an out-of-network facility might lead to higher costs. Checking your plan’s benefit summary or contacting your insurer directly can provide specific details about network requirements and costs.