What do you do if you can’t get to a doctor’s office and have a minor medical emergency? Urgent care centers are usually the solution to this problem. While they don’t provide care for life-threatening conditions, they do treat many common ailments from colds and flu to fractures and even asthma attacks.
You can even get vaccinated, have x-rays done, or have blood drawn for lab tests at some urgent care facilities. This is very helpful to those needing minor medical attention, but is urgent care covered by insurance, or is it paid out of pocket? And does it matter what kind of health plan you have?
These are all valid questions that you’ll want the answers to before heading to your nearest urgent care center. So keep reading to find out whether urgent care is covered by insurance.
Does Urgent Care Accept Insurance?
A majority of urgent care centers across the country are privately owned. However, most urgent care centers accept all major health insurance plans. Whether or not your particular treatment will be covered is almost always determined by the terms and conditions of your particular policy and tier level.
There are different types of coverage and these can also differ from one health insurance provider to the next. Some health insurance plans cover medical emergencies only, whereas others are more comprehensive and cover a wider range of treatments that urgent care would provide.
Another factor is that health insurance coverage can vary from state to state. Always check the terms and conditions of your particular policy before scheduling treatment or walking into an urgent care facility.
Popular health insurance plans, such as Aetna, Anthem, and UnitedHealthcare, are all accepted at most urgent care facilities.
Before attending an urgent care facility out-of-state or one that you are not familiar with, call ahead if possible to check if your health insurance plan is accepted. Doing so will save you the surprise that no one wants – having to hear that your insurance won’t cover your treatment.
Co-Pays & Co-Insurance
Regardless of your insurance plan, you’ll probably have to pay some sort of copay or coinsurance at an urgent care facility.
So, what exactly are copayments and coinsurance and how do they affect your costs at an urgent care facility?
- A copayment (or copay) is a set amount you’ll have to pay for services and drug prescriptions at medical facilities, including urgent care.
- Coinsurance is a percentage of the medical costs you’ll have to pay after meeting your deductible, with your health insurance paying the rest.
- Your deductible is the amount of the medical costs you’ll pay yourself before your health insurance starts paying some of the costs.
Benefits do, however, also differ depending on the pan you’re on, and the percentages these copays amount to will differ accordingly. You can therefore expect to pay roughly $20-40 despite having health insurance, and these costs may be far higher if you need extensive tests done.
Coverage for X-rays, lab tests, and even vaccinations is not always the same on every insurance plan and you’ll likely have to pay additional costs out-of-pocket.
Does Urgent Care Accept Medicare?
Urgent care centers do accept Medicare. But it’s important to note that not all urgent care centers are the same. Just like you get different health insurance providers and different health plans, there are also different urgent care facilities across the US.
Most urgent care providers accept health insurance like Medicare. Health insurance is, in fact, not required for treatment.
But with these health insurance plans, the determining factor in coverage is more often the specific plan you have, rather than the facility. That being said, urgent care facilities treat non-emergencies i.e. medical situations that are not life-threatening.
Medicare covers urgent care but you’ll be responsible for paying for 20% of the predetermined Medicare-approved amount if you have the part B plan of the original Medicare. Medicare Part B has a deductible that may be applied as well.
Despite this coverage, any additional tests and care may bear additional costs.
What Does Insurance Cover At Urgent Care Clinics?
The type of health insurance plan you have will determine the coverage you enjoy at urgent care centers. Your coverage may also be subject to a deductible, or you may need to make a copayment.
That being said, most general consultations and minor ailments are covered.
Examples of the ailments covered and treated at urgent care facilities include:
- Allergic reactions
- Sore throat & fever as in colds and flu
- Sinus infections
- Eye infections
- Dental complications and pain
- Headache & migraine
- Back pain
- Skin rashes
- Muscle sprains and strains
- Cuts & burns
Some, but not necessarily all, may also offer:
- Lab testing services
- EKG testing
However, at those urgent care centers which offer X-rays vaccinations, or lab tests, you may have to pay extra for those services.
What If I Can’t Pay?
If you have no health insurance or if there is some reason why your insurance can’t cover your treatment, some centers offer payment plans. This is done at the discretion of the facility and cannot be guaranteed at all urgent care centers.
But the best safeguard against such a situation is to get affordable health insurance. Subsidized health insurance plans are available for low-income and even no-income households.
The Difference Between Urgent Care Centers And Emergency Rooms
There are a few differences when it comes to urgent care vs emergency rooms.
- Urgent care centers offer short-term, usually single-visit treatments for non-life-threatening conditions. Emergency rooms offer treatment for potentially life-threatening conditions.
- Emergency rooms can have long waiting times, as they deal with many more medical complaints. Urgent care centers typically have short or negligible wait times.
- Urgent care centers have hours of operation that may differ from one facility to the next. Emergency rooms are accessible 24/7.
- If you don’t have health insurance, you’ll pay out of pocket for urgent care services. Hospital emergency room treatment is available whether you can pay or not. All ACA subsidized insurance plans automatically cover emergency room treatments.
Is It Better To Have Private Or Subsidized Health Insurance (Like Obamacare) At Urgent Care Centers?
In general, the coverage you receive will be similar, although there are sometimes more comprehensive options available to you on private health insurance.
You’ll be able to choose your doctor, rather than go to one that is approved by subsidized health plans. And you may even have a shorter waiting time at facilities like emergency rooms and urgent care facilities.
Other than that, it doesn’t matter if your health plan is a subsidized one or not. Urgent care facilities don’t necessarily favor one over the other. Some subsidized health insurance plans offer fairly comprehensive coverage.
Frequently Asked Questions About Urgent Care
Are urgent care clinics more expensive than private doctor consultations?
No, urgent care centers are not usually more expensive than doctor’s rooms. That is why many uninsured people tend to prefer urgent care to doctor’s room visits.
However, their fee structures do differ depending on the facility and the treatment. Costs will add up pretty quickly, which without insurance is a cause for concern.
Do urgent care clinics offer ante-natal and reproductive health services?
Some urgent care centers offer a range of reproductive health services. If the urgent care center in your area does not, you can access reproductive health services at community sexual health clinics.
You can have STD testing, as well as pregnancy tests and ultrasound scans at most urgent care centers, too.
Will urgent care clinics treat undocumented immigrants or migrant workers?
Undocumented immigrants can receive care at an urgent care center but will have to pay out of pocket unless they have private health insurance.
Unfortunately, subsidized plans under the Affordable Care Act (ACA) are only available to qualifying US citizens. However, in the state of California, certain exceptions are made.
Do you need to book an appointment to go to urgent care?
No, you do not need to book an appointment to be treated at an urgent care facility. However, you may have to wait a little while to be seen.
Some urgent care centers do take appointments if you do want to book one and skip any potential queues. You could also check to see if any urgent care centers near you have an online waiting list that you can put your name on before showing up.
Urgent care clinics can be a more affordable option than doctor’s room visits, but they aren’t always that cheap. And when you don’t have insurance, that can put a serious dent in your finances.
Most urgent care centers accept various types of health insurance, so it’s a good idea to get yourself some coverage. At Enhance Health, we help you compare health plans and find the right one for your needs. If you have a low or even no income, we can advise you about subsidized plans on the marketplace.