Does Medicare Cover Urgent Care Visits?

Medicare typically covers urgent care visits, providing a valuable option for medical needs that are not life-threatening but require prompt attention. This coverage helps individuals access timely care for sudden illnesses or minor injuries when a primary care physician may not be immediately available.

Medicare Parts and Urgent Care Coverage

Original Medicare, specifically Medicare Part B, covers medically necessary urgent care services. Urgent care centers provide outpatient services for conditions that are not emergencies but need quick treatment, such as infections, minor cuts, or sprains. Medicare Part B covers 80% of the Medicare-approved amount for these services after the annual deductible has been met.

Medicare Advantage Plans (Part C) are offered by private insurance companies and are required to cover at least the same services as Original Medicare Part A and Part B. This means urgent care visits are included in Medicare Advantage plans. These plans may have different rules for accessing urgent care, including specific networks of providers.

Medicare Advantage plans often integrate additional benefits beyond Original Medicare, such as prescription drug coverage, vision, or dental. While they cover urgent care, the exact terms, such as copayments and network requirements, can vary significantly from one plan to another. Beneficiaries should review their plan’s details to understand their specific urgent care benefits.

Medicare Supplement Insurance (Medigap) helps cover some of the out-of-pocket costs associated with Original Medicare. If an individual has Original Medicare and a Medigap policy, the Medigap plan can help pay for the Part B deductible and the 20% coinsurance for urgent care services. Medigap policies work with Original Medicare and do not apply to Medicare Advantage plans.

Patient Costs for Urgent Care

Patients with Original Medicare (Part B) are responsible for out-of-pocket costs for urgent care visits. Individuals must first meet their annual Part B deductible, which is $257 in 2025. After the deductible is satisfied, Medicare Part B covers 80% of the Medicare-approved amount for urgent care services.

The remaining 20% of the Medicare-approved amount is the patient’s coinsurance responsibility. This coinsurance can accumulate, especially if multiple services or diagnostic tests are performed during the urgent care visit.

For those enrolled in a Medicare Advantage plan, the costs for urgent care visits typically involve a fixed copayment per visit. These copayment amounts vary widely among different Medicare Advantage plans. Some plans may have lower copayments for urgent care compared to emergency room visits, encouraging appropriate use of services.

Medigap plans can significantly reduce a patient’s out-of-pocket expenses under Original Medicare. Depending on the specific Medigap plan chosen, it may cover the Part B deductible, the 20% coinsurance, or both.

Accessing Urgent Care with Medicare

Urgent care centers are suitable for conditions that require prompt medical attention but are not severe enough to warrant an emergency room visit. These facilities treat a range of non-life-threatening issues, including minor infections, colds, flu, sprains, minor cuts, and conditions like persistent vomiting or diarrhea.

Before visiting an urgent care center, confirm that the facility accepts Medicare. Most urgent care centers across the United States are Medicare-participating providers. If a center does not accept Medicare assignment, patients may be required to pay the full amount upfront and then file a claim with Medicare for reimbursement.

For individuals with Original Medicare, there are generally no network restrictions, meaning they can visit any urgent care center that accepts Medicare. However, those with a Medicare Advantage plan should prioritize using in-network urgent care centers to ensure optimal coverage and avoid higher out-of-network costs.

To locate Medicare-approved urgent care centers, beneficiaries can utilize online search tools provided by Medicare or their specific Medicare Advantage plan. These resources often allow users to search for providers and facilities that participate in their plan’s network.