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Is Urgent Care Covered by Medicare?

Key Points

  • Like most insurance companies, Medicare has an approved rate that it pays for individual medical procedures. Most urgent care centers will accept that amount, which means you can use your Medicare coverage, however, some facilities have not made that agreement.
  • Some physicians have chosen to opt out of Medicare and refuse to treat patients with this insurance. They require Medicare patients to sign a private contract stating that the patient may not file claims with Medicare for services rendered.

If you require urgent medical care, you might wonder if urgent care centers accept your insurance. In the case of Medicare, this issue can be a little tricky and will depend on your specific Medicare plan. Here are the basic facts about urgent care centers and Medicare.

Is Urgent Care Covered by Medicare?

Key Points

  • Like most insurance companies, Medicare has an approved rate that it pays for individual medical procedures. Most urgent care centers will accept that amount, which means you can use your Medicare coverage, however, some facilities have not made that agreement.
  • Some physicians have chosen to opt out of Medicare and refuse to treat patients with this insurance. They require Medicare patients to sign a private contract stating that the patient may not file claims with Medicare for services rendered.

If you require urgent medical care, you might wonder if urgent care centers accept your insurance. In the case of Medicare, this issue can be a little tricky and will depend on your specific Medicare plan. Here are the basic facts about urgent care centers and Medicare.

Urgent care centers vary

Original Medicare is a federal insurance plan for those 65 and older and people with specific disabilities or medical conditions. Like most insurance companies, Medicare has an approved amount that it pays for individual medical procedures.

Most urgent care centers will accept that amount, which means you can use your Medicare coverage at that walk-in clinic. However, some facilities have not made that agreement, and they will let you know that you cannot use your Medicare coverage with them.

That means that while most urgent care centers will accept Medicare unconditionally, there may be a few locations that will choose not to do business with Medicare-covered patients. These locations are rare and are very open about this policy.

In some cases, there will be urgent care centers with doctors who do treat Medicare-covered patients and doctors who will not see Medicare-covered patients. The centers will explain this to you if you should encounter it.

The gist is that while Medicare does cover urgent care, urgent care centers each have the right to accept or deny any insurance provider. However, it is rare to find a center that does not accept Medicare insurance.

Opt-out physicians

Some physicians have chosen to opt out of Medicare and refuse to treat patients with this insurance. They require Medicare patients to sign a private contract stating that the patient may not file claims with Medicare for services rendered.

However, according to federal regulation 40.28, which went into effect in January of 2013, patients at urgent care facilities may be treated by these opt-out physicians. The physicians are subject to additional paperwork, but the patient will not experience issues.

This is because Medicare will pay for covered services in an emergency or urgent need situation. This is true even if a medical provider has opted out of providing Medicare services.

Accepting physicians

Medicare-covered patients who find Medicare-accepting doctors will pay less and experience less hassle filing claims. These doctors have agreed to pre-determined fee schedules, so there is no discrepancy in filing claims.

Patients with Medicare can rest assured that there are facilities that accept their insurance. By being prepared with the facts beforehand, your office visits will go more smoothly, and you will enjoy greater peace of mind.

Medicare Advantage plans have their own networks

If you don’t have Original Medicare but instead have a Medicare Advantage plan, you will want to ensure that the urgent care clinic is within your provider network. Medicare Advantage plans get issued by private insurance companies, and while they often offer additional benefits, they may not cover as many medical providers.

Remember that if you need emergency care, you can often visit a clinic even if it’s not within the provider network, and you’ll receive coverage. However, it’s helpful to visit an in-network clinic if possible to minimize the paperwork.

You can get the urgent care you need

If you have Medicare or Medicare Advantage, you’ll be able to use your insurance to get the care you need. You just might need to check if the facility you’re planning to visit accepts Medicare or your Advantage plan.

It can be helpful to make a plan so that you know which urgent care clinics are part of the provider network. That way, in an emergency, you don’t have to spend extra time finding the right facility.

Search urgent care providers in your area using the tools available from Solv. We can help you find a clinic that can help you as soon as possible.

Sources

Solv has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

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