Does Medicare Cover Urgent Care Visits?

Urgent care visits offer access to immediate medical attention for unexpected injuries or illnesses. Medicare will cover these visits and any treatment or procedures you receive during your visit under Part B.

Urgent care clinics also offer other Medicare-covered services outside of immediate illness and injury. For example, you can receive annual physicals and X-rays at clinics, as well as vaccine and immunization shots.

Remember, an urgent care visit is for minor, unexpected medical conditions. Anything more serious would require a trip to the emergency room.

Medicare also covers emergency department services for these situations.

If you have Original Medicare — Part A and B, collectively — then 80% of the cost for treatment and services received at an urgent care clinic will be covered.

With Part B, you will have to meet a deductible before coverage begins. After the deductible has been met, you pay 20% of the Medicare-approved cost.

You will also have to pay a copayment if you receive care in a hospital outpatient setting.

Urgent care visits are also covered through a Medicare Advantage plan since they include everything covered in Original Medicare.

Medicare Advantage plans also include additional benefits and coverage and what is offered in Part A and Part B.

Check with your plan provider to learn about any expanded coverage available related to urgent care trips.

As a result of your urgent care clinic, a doctor or healthcare provider may recommend a prescription drug to help you recover from your injury or illness.

Prescription drug coverage is not available through Original Medicare — but is covered by Medicare Part D as an optional benefit through private insurers.

As with most Part B coverage, your urgent care visit will only be covered if the clinic you visit and the doctor or healthcare provider who treats you are enrolled in Medicare.

It is important to inquire about this before you receive any services to make sure that you are covered. If not, then you will have to pay out-of-pocket for any treatment you receive.

However, you can file a Medicare reimbursement claim later to get your money back even if the clinic is not enrolled.

When filing the claim, you will need to include the bill from the doctor or clinic as well as a letter explaining your reasoning for wanting reimbursement. You can find the form to fill out here.

You must file the claim within a year of when you received the services in question.

If you have a Medicare Advantage plan, then you do not need to file a claim.