Does Medicare Cover Urgent Care?

We’ve all been there — we feel sick, but we know it’s not life-or-death, so going to the emergency room seems dramatic. But, it might be after-hours, or your regular doctor may not be available and you still need to be seen now, not later. Enter urgent care. These facilities bridge the gap between the life-saving purposes of often crowded emergency rooms and the lack of availability of most primary care physicians on short-notice.

Medicare Benefits Solutions

Nov 20, 2020

 4 minutes read

What conditions are treated at urgent care?

Anything short of an acute, life-threatening condition can usually be treated at an urgent care center. The problem is, you might not realize if what you’re experiencing is something serious that warrants rushing to the hospital, instead. That’s why most urgent care centers will offer you a brief questionnaire to help you review your symptoms. 

Generally, you can expect providers at urgent care to advise you to seek out emergency treatment at a hospital if you’ve been in an accident or your symptoms are severe or excessive. Do you have a sore throat? Urgent care can probably help you. Are you struggling to breathe? That justifies a trip to the emergency room. If you measure the severity of your pain or symptoms by a similar scale, you can better understand what you might have treated an urgent care center.

Despite its name, urgent care centers can also provide routine exams, vaccines and medical waivers as part of their services. These may be available only by appointment or during certain seasons, and you may need to check if your insurance covers that treatment when given at an urgent care center versus your primary care physician. It’s possible the urgent care center will need verification from your primary care physician that they are not available for an appointment in order for your urgent care center to be able to bill for your care, instead.

Medicare coverage for urgent care

With Original Medicare, you’ll be covered under Medicare Part B policy rules for an urgent care visit. This means you’ll have your yearly deductible to meet if you haven’t met it yet, as well as a 20% coinsurance to pay. If you have a Medigap or Medicare Advantage plan, the monthly premium you pay to that plan may mean out-of-pocket expenses at the point of service are already covered. The same applies if you have dual eligibility with Medicaid. 

Medicare Part B may also cover the cost of diagnostic work done on-site or any medication that is administered by the doctor or nurse on duty. Your healthcare specialists at the facility can help you determine what services may be covered or not if you’re in doubt, but Medicare can also reimburse you for costs that should have been covered but may have been billed to you directly.

If you need urgent care while out of the country and have Original Medicare, only certain Medigap plans with travel coverage will help you mitigate those bills. The last thing you need when you’re looking for urgent care away from home is to worry about the bill. There are some pretty particular rules about when the overseas coverage can apply, so make sure you read up on those conditions before you travel.

If you’re enrolled in a Medicare Advantage (MA) plan, you will have at least the same benefits as Original Medicare. Many MA plans include additional coverage, as well. Check with your plan directly to find out details about your urgent care coverage.

Got questions?

Call a licensed sales agent at

877-406-1753 or TTY 771

Mon – Sun 5am to 8pm PST (Closed Thanksgiving)

Send us a message

We aim to reply within 24 hours.

    Medicare Benefits Solutions is a non-government website. This is a solicitation for insurance. By submitting information on this site, I am providing my written consent for Medicare Benefits Solutions, herein after referred to as “Medicare Benefits”, which is a brand operated by HealthCompare Insurance Services Inc., its sales agents, or affiliates to contact me (even if I’m on a state or national do not call registry) at the phone number or email address listed to provide me with quotes or information about Medicare Advantage, Medicare Supplement, and Medicare Part D plans. I further consent to such calls or texts sent via autodialer, automated technology, prerecorded message and/or artificial voice. I understand my consent is not a condition of purchase and that I can revoke my consent at any time via Additional charges may apply to SMS, call, or Internet usage depending on your data providers.

    Find a plan

    Get plan recommendations

    Compare your current Medicare plan to our recommendations – then choose the plan that gives you more of the things you want.

    Find a new Medicare plan

    Click here to find out more

    Get a plan recommendation based on what's important to you.