How Do Urgent Care Centers Work with Medicare?

Integrity Urgent Care is pleased to announce that we accept Medicare! 44 million Americans over the age of 65 receive Medicare benefits. If you are a Medicare recipient, it’s important to understand the difference between an emergency room and an urgent care center. Is an urgent care center the right choice for you? Read on!

What is urgent care?
The first urgent care clinics in the United States opened in the 1970s and today, there are more than 10,000 urgent care centers nationwide. Urgent care centers are walk-in clinics equipped to handle all non-life-threatening illnesses and injuries such as lacerations, possible fractures, burns, allergic reactions, rashes, and the flu. No appointment is necessary, and they are open on weekends, many holidays, and evenings.

How do urgent care centers differ from emergency rooms?
Emergency rooms should be utilized only in life-threatening situations or when immediate care is required outside of urgent care center hours. An emergency room visit is necessary for major trauma, loss of consciousness, heart attacks, chest pain, and uncontrollable bleeding. They are much more expensive than urgent care centers and often have much longer wait times. The average cost of an urgent care visit is $150, and nearly all procedures are covered by insurance. The average cost of an emergency room visit is $1,233. The average wait time at an urgent care center is less than an hour, compared with an average wait time at an emergency room of 244 minutes.

How do urgent care centers work with Medicare?
If you have Medicare coverage, it’s important to know that both emergency care and urgent care fall under Part B – Outpatient Care. This means that the patient is responsible for 20% of the cost. Therefore, you will pay much more out of pocket for an emergency room visit ($246 on average) vs. an urgent care center visit ($30 on average). You will also have a much longer wait time at an emergency room.

If you have Medigap coverage in addition to Medicare, the financial result will often be the same; Medicare will pay 80% of the cost and your Medigap coverage will cover the remaining 20%.  However, you will have a much longer wait time at an emergency room.

If you have Medicare Advantage insurance, you pay a lower premium for coverage, but probably know that there are more restrictions on your coverage. Some doctors and hospitals may be out of network. However, all types of Medicare Advantage insurance cover emergency room and urgent care visits and you will be able to visit an urgent care center without a referral. Your out of pocket cost will depend on the type of plan, but will always be less than an emergency room.

The vast majority of ER visits could have been treated at an urgent care center much more quickly and for a fraction of the cost. If you are facing a life-threatening emergency, you should immediately go to the emergency room. Otherwise, Medicare patients will save a significant amount of time and money by going to an urgent care center instead.

Integrity Urgent Care is open daily from 8 am – 8 pm. Walk-ins are encouraged and appointments are never necessary. Call us today for more information: (979) 703-1832.

Sources: https://boomerbenefits.com/urgent-care-vs-emergency-care-while-on-medicare/, https://boomerbenefits.com/medicare-advantage/, https://integrityuc.com/Blog/ArticleID/14, https://medicare.com/medicare-advantage/medicare-advantage-plans/, https://www.immediateclinic.com/history-urgent-care-and-how-it-has-evolved