Medicare covers Urgent Care centers; sometimes, beneficiaries save more money by going to urgent care than the ER. If the care you need is severe, the ER is the only place for you.
However, if you have a small issue, the urgent care center is a good option.
A trip to the emergency room is necessary if you feel you’re in peril. That is, you think you’re in danger of losing your life, a limb, or the function of a body part.
Life or death scenarios justify the need and cost of the emergency room.
The emergency room is open 24 hours a day, seven days a week. An emergency room is rigged to allow medical staff the ability to respond to any dilemma that presents for treatment.
ER’s employ doctors, nurses, and specialists.
They have at their disposal x-ray machines, MRIs, CT scanners, ultrasound machines, and many more devices that can be used to help in a patient’s diagnosis.
Also available are surgical rooms, medications, blood, and plasma.
Whatever the emergency, saving lives happens in an emergency room. The ER is ready for every contingency. That’s why every service available cost more.
The ER is for falling off a motorcycle on the highway and rolling into a ravine.
On the other hand, an urgent care center can treat injuries or illnesses that are not life-threatening.
Difference Between Emergency Rooms and Urgent Care Centers
For example, it would be prudent to use a Medicare urgent care center if you need stitches.
You would save hundreds of dollars getting stitches at an urgent care center as opposed to getting stitches in the emergency room.
And while a urinary tract infection may feel like the emergency room is necessary. You can save hundreds by taking advantage of the urgent care center.
The urgent care center usually has medications on hand. Meaning you may not have to stop by the pharmacy to get that prescription filled.
Situations that would be considered urgent but not life-threatening are opportunities to utilize an urgent care center.
Over and above the cost-saving features of the urgent care center, you can rely on them to be open earlier, later, the weekend and holidays.
It’s no wonder the baby boomer generation has found great value in the use of urgent care facilities instead of over-utilizing the emergency room.
Do Urgent Care Facilities Accept Medicare
Yes, most urgent care facilities do accept Medicare. If the urgent care facility accepts Medicare, they will also take your Medigap plan.
Occasionally a recipient comes across an urgent care center that accepts Medicare but is out of network with the Advantage plan. It’s essential to ask the facility each time before getting treatment.
How Much Does Medicare Pay for an Urgent Care Visit
An urgent care visit is payable under Part B, the medical insurance portion of your coverage. Part B has a yearly deductible, and after that, Medicare pays 80%.
If you have a Medigap plan, your secondary insurance will pick up according to your policy provisions. For instance, if you have a supplement plan G and you’ve met your Part B deductible, you pay nothing for treatment rendered at an urgent care center.
Can I Get Reimbursed if the Urgent Care Center Doesn’t Take Medicare
Medicare will cover services at an urgent care center. However, if the doctor has opted out, they may ask you to sign a contract stating you won’t bill Medicare.
According to Federal regulation 40.28, passed in 2013, even opt-out doctors will have to provide urgent care and then complete additional paperwork to get paid by Medicare. Medicare will pay based on this regulation.
These opt-out providers cannot bill Medicare for follow up care and thus would refer you back to your primary doctor.
Do Urgent Care Facilities Accept Medicare Advantage Plans
Beneficiaries should expect to pay only a copayment for essential services provided at the urgent care center. Although, you’ll want to stay in-network with your Medicare Advantage plan.
Often, urgent care center copayments are $75-$125.
Unless you have a money tree in your back yard, the cost difference is substantial. The use of the urgent care center is payable under your Part B.
When you go to the emergency room, the benefits fall under Part A. The Part A deductible is a significant increase over the Part B deductible.
A client of ours had a stomach problem that wouldn’t seem to go away, let’s call her Kelly.
Kelly would feel better for a few days, and then her pain would come back with a vengeance.
By the time Kelly knew medical attention was essential, it was Wednesday night, and her primary care doctor was not open.
Her symptoms had reached a breaking point, and she asked her husband to take her to the emergency room.
It turns out that in addition to the stomach problems, Kelly didn’t have enough hydration.
The overall cost for this little adventure was about $3,000, that’s with private insurance.
If Kelly goes to a Medicare urgent care center, her share would be a $50 copayment, plus the cost of IV hydration.
While you can start to see the financial efficiency, urgent care centers are bringing to our communities, keep in mind your copayment, and cost-share will vary depending on the coverage.
Difference in Care
The doctors and nurses that work in urgent care facilities and hospital emergency rooms care about patients and have a desire to help other people. Otherwise, they would be a different profession.
Everyone knows that emergency rooms treat the most traumatic patients first. Unless you’re having chest pains, uncontrollable bleeding, or significant trauma, you’re going to take a seat and wait your turn. Wait time for the emergency room is an average of 2.5 hours.
Urgent care facilities can run basic labs, offer IV hydration, see patients within 15 minutes of arrival.
Also, they treat the following conditions and more:
- Flu, colds and sore throat
- Sinus, ear, and eye infections
- Urinary tract infections
- Sprains, strains, and minor fractures
- Animal and insect bites
- Laceration and wound care
- Camp, school and sports physicals
- X-ray and EKG
- Non-narcotic medication dispensing
Some urgent care centers even allow you to visit their site, either online or through an app on your phone, where you can save your spot in line. Gone are the days of waiting for hours in a hard chair when all you want is someone to make you feel better and tuck you in bed.
Be proactive and know before you need it; find an urgent care facility that accepts Medicare and most other insurance plans, in any area.
Benefits of Urgent Care vs Emergency Room
The first and most obvious benefit is cost. Urgent care centers tend to be cheaper than Emergency Room visits.
Further, the time spent in Urgent Care is typically less than the time you’d spend in the ER. However, if you have a life-threatening issue, consulting the ER may be necessary.
Those with a non-life-threatening illness could benefit financially by choosing an Urgent Care facility. Plus, with Medigap Plan N, you don’t pay a copayment for Urgent care; however, you pay a $50 copayment for the ER when they don’t admit you.
Also, Medicare Advantage plans are likely to have higher copays in the ER than they do in the Urgent Care facility.
Control your Medical Dollars
It takes a few minutes of planning, but if you spend ten minutes today deciding where you’ll seek treatment when faced with a non-life threatening “emergency,” you could save thousands of dollars down the road.
That’s several rounds of golf or a dozen new pairs of shoes. By planning, you stay in control and elect where you spend your money.