Does Medicare Part A Cover Urgent Care Visits?

Medicare is a federal health insurance program designed to provide coverage for various medical services. It primarily serves individuals aged 65 or older, but it also extends to some younger people with certain disabilities and those with End-Stage Renal Disease. The program aims to help beneficiaries manage healthcare costs.

Understanding Medicare Part A Coverage

Medicare Part A, often referred to as Hospital Insurance, primarily covers inpatient care received in hospitals, including critical access hospitals. It also extends to skilled nursing facility care, which is provided after a qualifying hospital stay. Additionally, Part A covers hospice care and certain home health services for eligible beneficiaries. This component of Medicare focuses on significant medical events requiring facility-based or specialized care.

Defining Urgent Care Centers

Urgent care centers are medical facilities that provide immediate treatment for non-life-threatening illnesses or injuries. These centers serve as a bridge between a primary care physician’s office and a hospital emergency room. They are suitable for conditions that require prompt attention but are not severe enough to warrant an emergency department visit, such as minor infections, sprains, or colds. Urgent care facilities offer convenient walk-in access, often with extended hours, and can provide services like X-rays, lab tests, and vaccinations.

Medicare Part A Coverage for Urgent Care Visits

Medicare Part A generally does not cover urgent care visits. This is because Part A is specifically designed for inpatient services, such as hospital admissions, rather than outpatient care. Urgent care services are typically considered outpatient.

However, in very rare instances, if an urgent care visit directly results in an inpatient hospital admission, the costs associated with the urgent care services might be bundled into the Part A-covered inpatient stay. This scenario is uncommon, as Part A’s primary purpose is to cover costs once a beneficiary is formally admitted as an inpatient. For care where a patient is treated and released without inpatient admission, Part A typically does not apply.

How Medicare Part B Covers Urgent Care

Medicare Part B, known as Medical Insurance, is the component of Original Medicare that typically covers urgent care visits. Part B is designed to cover medically necessary outpatient services, including doctor visits, preventive services, and various diagnostic tests. When a beneficiary visits an urgent care center, the services received, such as medical evaluations, diagnostic tests like X-rays or blood work, and treatment for minor injuries or illnesses, generally fall under Part B coverage.

Under Medicare Part B, beneficiaries are responsible for certain out-of-pocket costs. For 2025, the annual Part B deductible is $257. Once this deductible has been met, Medicare Part B typically pays 80% of the Medicare-approved amount for covered services. The beneficiary is then responsible for the remaining 20% coinsurance.

For example, if an urgent care visit costs $200 and the deductible has been met, Medicare would pay $160, and the beneficiary would owe $40. It is important to confirm that the urgent care center accepts Medicare assignment to ensure optimal coverage and avoid higher out-of-pocket expenses. Some urgent care centers may also charge a separate copayment for the visit.