Does Medicare Pay for Urgent Care Visits?

Medicare is a federal health insurance program for individuals aged 65 or older, younger people with certain disabilities, and those with End-Stage Renal Disease. Urgent care centers offer a convenient option for medical needs that are not life-threatening but require prompt attention, bridging the gap between a primary care office and an emergency room. This article clarifies how Medicare beneficiaries can access and pay for urgent care services.

Understanding Urgent Care under Medicare

Urgent care refers to medical services for illnesses or injuries not severe enough for an emergency room, but which cannot wait for a primary care doctor’s appointment. These conditions typically require attention within 24 hours. Urgent care centers handle a range of non-emergency issues, offering a more accessible and often less costly alternative to hospital emergency departments.

Common conditions treated include minor infections like colds, flu symptoms, urinary tract infections, and strep throat. They also address minor injuries such as sprains, strains, small fractures, and cuts that may need stitches. Medicare covers services at urgent care centers when they are medically necessary. This means a healthcare professional determines the services are reasonable and required for the diagnosis or treatment of an illness or injury.

Medicare Parts and Urgent Care Coverage

Different parts of Medicare provide coverage for urgent care services. Understanding these distinctions helps beneficiaries anticipate how their costs and access might vary. The primary components involved are Medicare Part B and Medicare Part C, while Part A plays a more limited role.

Medicare Part B, which is medical insurance, generally covers outpatient services, including visits to urgent care centers. If you have Original Medicare, your urgent care visit falls under Part B’s outpatient services, provided the facility and services meet Medicare’s requirements.

Medicare Part C, known as Medicare Advantage, offers another way to receive Medicare benefits through private insurance companies approved by Medicare. These plans must cover at least the same services as Original Medicare (Parts A and B), including urgent care. However, Medicare Advantage plans often have specific provider networks and may require referrals, so check your plan’s rules and network before visiting an urgent care center.

Medicare Part A, which is hospital insurance, primarily covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. An urgent care visit is typically an outpatient service. Part A would only become relevant if the urgent care visit led to an inpatient hospital admission, covering the hospital stay, but not the initial urgent care visit.

Your Costs for Urgent Care

Understanding the financial responsibilities for urgent care visits is important for Medicare beneficiaries. Costs vary depending on whether you have Original Medicare or a Medicare Advantage plan.

For those with Original Medicare, you typically pay a deductible and then a coinsurance for services. In 2025, the annual Medicare Part B deductible is $257. After meeting this deductible, you are usually responsible for 20% of the Medicare-approved amount for most outpatient services, including urgent care.

Medicare Advantage Plans (Part C) have different cost-sharing structures, varying significantly by plan. They typically charge a copayment for each visit, rather than a coinsurance percentage. The copayment amount can differ widely, so reviewing your plan’s Summary of Benefits is essential to understand your specific financial responsibility.

Medicare Supplement Insurance, also known as Medigap, can help cover some out-of-pocket costs associated with Original Medicare. A Medigap policy can assist with paying the Part B deductible and the 20% coinsurance for urgent care services. This can significantly reduce your financial responsibility. Other health insurance, such as employer-sponsored coverage, may also coordinate with Medicare, potentially affecting your costs.

Preparing for an Urgent Care Visit

Taking a few preparatory steps can help ensure a smooth experience when visiting an urgent care center. Having necessary documents and information available streamlines registration and billing. Confirming coverage and knowing what to expect after your visit contributes to managing your healthcare effectively.

Bring your Medicare card and a photo ID to the urgent care center. Also, bring a current list of all medications you are taking, including dosages, and any known allergies. If you have a Medicare Advantage plan or a Medigap policy, bring those insurance cards as well. This information helps staff provide appropriate care and process your visit.

Before visiting, confirm the facility accepts Medicare. If you have Original Medicare, ensure they accept Medicare assignment. If you have a Medicare Advantage plan, verify the urgent care center is within your plan’s network by calling or checking your plan’s provider directory. This step prevents unexpected out-of-network charges.

After your visit, you will receive an Explanation of Benefits (EOB) from Medicare or your Medicare Advantage plan. This document details services received, total charges, the amount Medicare paid, and your financial responsibility. Review the EOB carefully and contact the billing department or your insurance plan with questions. Follow up with your primary care physician to ensure continuity of care and update your medical records.