Medicare and Urgent Care Facilities: Is Urgent Care Covered by Medicare?

We’ve all been there – you have a minor health concern and would much rather go to an urgent care facility than the alternatives. After all, it’s not serious enough for the emergency room, and it’s often difficult to see your doctor without scheduling an appointment in advance.

Common conditions that are perfect for an urgent care facility rather than the emergency room include:

• Allergies
• Minor burns
• Asthma
• Minor cuts
• Bug bites
• Pink eye
• Cold
• Rash
• Congestion
• Sore throat
• Diarrhea
• Urinary Tract Infection in adult women
• Fever
• Sinus infection
• Flu
• Headache
• Sprains

Most of the time, the doctor or physician will do some basic health checks, like weight and blood pressure, and they’ll write you a prescription for your ailment. If you’re experiencing a concern that’s much more serious than the examples above or is life-threatening, please go to the emergency room.

When you’re on Medicare, you do have coverage for urgent care facilities. However, depending on what kind of insurance set-up you have, your coverage will differ slightly.

Original Medicare and Urgent Care Coverage

If you only have Original Medicare and no supplemental health coverage, you’ll be covered for urgent care under Medicare Part B, because urgent care is considered outpatient care.

Medicare Part B has a deductible ($183 as of 2018), and after the deductible is met, you typically pay a 20% coinsurance on the Medicare-approved amount.

So, if you only have Original Medicare, you’d be looking at paying fees up to $183, and then 20% of the fees after that (as long as the service is approved by Medicare).

Medicare Supplements and Urgent Care Coverage

If you have a Medicare Supplement, your urgent care visit will be much cheaper (or even free).

For those with Medicare Supplement Plan F, you have no deductible, no copays, and no coinsurance. This means that as long as the urgent care service is approved by Medicare, your visit will cost you nothing.

For those with Medicare Supplement Plan G, you have no copays or coinsurance, but you do have a $183 deductible for the year. This means your urgent care service would cost you up to $183, and then nothing after that. Keep in mind that you only have to meet the $183 deductible once per year – after that, every service that is approved by Medicare will be covered in full.

For those with Medicare Supplement Plan N, you have a copay of up to $20 for the visit and the $183 deductible, but no coinsurance. Also, with Plan N, you must confirm that the urgent care location accepts Medicare assignment.

If you have Medicare Supplement Plan A, B, C, D, K, L, or M – and we don’t recommend any of these plans to our clients – your coverage may not be as great. Since these plans aren’t popular, we won’t go into detail, but please contact us if you need more information on how urgent care is covered with these specific Medigap plans.

Medicare Advantage and Urgent Care Coverage

With Medicare Advantage, the law is that the insurance must provide the same coverage as Medicare – or better. So, you can rest assured that urgent care is covered through Medicare Advantage plans, though the amount of coverage will differ from plan to plan.

One thing to keep in mind is that Medicare Advantage plans have networks, so you’d need to confirm that the urgent care facility you’re interested in is within your plan’s network.

Check with your plan’s benefits, or ask your agent how urgent care is covered if you do have a Medicare Advantage plan.

Urgent Care Options in Decatur, IL

In Decatur, there are really only two urgent care options for seniors, and both are through DMH. DMH Express Care East, located on US-36, and DMH Express Care North, located on Water Street, are both urgent care facilities that accept walk-in visits. Their hours are 7am-7pm during the work week and 8am-6pm on the weekend.

Both locations are staffed by board-certified physicians, and they offer on-site laboratory and x-ray. In addition to treating common medical issues, you can get the following minor procedures done at one of these urgent care facilities:

• Minor laceration repairs
• Ingrown toenail removal
• Treatment of warts
• Foreign body removals
• Drainage of boils

You can get lab testing done there as well, such as:

• Blood sugar
• Hemoglobin
• Strep and throat infections
• Mono
• Influenza A and B
• Urine testing for bladder infections
• TB testing for physicals
• Drug screens – both rapid and send outs
• Breath alcohol testing

Both locations also offer a free walk-in service for blood pressure checks. The DMH urgent care locations accept Medicare as well as Medicare Advantage plans.

St. Mary’s Hospital does offer an urgent care service online called “Anytime Care,” but it’s not available for seniors. A representative explained to us, “Because of governmental insurance, the virtual care would not be an option. There are governmental restrictions that don’t allow us to provide services to patients with governmental insurance. This includes Original Medicare and Medicare Advantage.”

If you know of any other urgent care facilities in the Decatur, IL area, please comment them below!

Making the Most of Your Urgent Care Visit

Since you’re not seeing your regular doctor for this visit, it’s important that you make the most of your visit.

Here are a few tips:

1. Be prepared to talk about your health history.

The doctor or physician is probably seeing you for the first time, so it’s important that you give a good picture of your health and medical history. Even if you think something isn’t relevant, tell the doctor anyway!

Make sure you know the medications you’re taking (names and doses) as well as any recent health concerns or surgeries.

2. Describe your main issue in great detail

You’re obviously going to urgent care for a minor health issue, but be sure to explain it in detail. The last thing you want is to leave out information and potentially leave the clinic without being fully treated.

Think about how long you’ve had the symptoms, whether they’ve gotten worse, if you’ve had this issue before, if you’ve tried anything to help and whether or not it worked, and so on.

3. Leave the urgent care facility with complete understanding

Don’t leave the urgent care facility without feeling totally comfortable with the diagnosis and treatment plan. Make sure you know the following things before you go:

• What’s the official diagnosis?
• When should I expect to feel better?
• What should I do if it doesn’t get better?
• What medication will I be taking, and what do I need to know about it?
• Should I come back or schedule an appointment with my regular doctor for any reason?

While we want to rely on doctors and physicians to cover everything, we’re ultimately responsible for our health and wellness. Take an active role during your visit by asking lots of questions and providing information – even if the doctor hasn’t asked about it.

Again, if you know of any other urgent care facilities in the Decatur, IL area, please comment the name of them below!‍