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Medicare Coverage for Urgent Care: Here’s What You Need To Know

Navigating healthcare coverage can sometimes (or oftentimes) feel like figuring out how to get out of a complicated maze. If you're covered by health maintenance organizations (HMOs) like Medicare, understanding whether your insurance covers urgent care services is essential for making informed decisions about your health.

More often than not, we visit urgent care centers more than we do hospitals for a variety of reasons, which also vary in urgency: unanticipated injuries or illnesses such as minor fractures, urinary tract infections, and vomiting or diarrhea; annual physical exams; vaccination; and other diagnostic procedures for unexpected and minor medical conditions.

Does Medicare Cover Urgent Care Visits?

The good news is that Medicare covers urgent care visits and any necessary treatments or procedures performed during the visit. This coverage falls under Medicare Part B, which is designed to cover outpatient services and preventive care. Once you meet the Part B deductible, Medicare covers 80% of the cost of a visit, and you pay the remaining 20%.

Common Injuries and Conditions Covered by Medicare

Urgent care visits are ideal for minor medical conditions requiring immediate attention but not life-threatening. Here at Crimson Care, we can help you with the following injuries or conditions:

  • Cough

  • Fever

  • Bleeding from a cut

  • Minor broken bones or fractures

  • Rashes

  • Urinary tract infections

  • Vomiting and/or diarrhea

  • Acute & Minor Burns

  • Breaks & Sprains

  • Earache, Fever, Cold, Flu, & Allergies

  • Pediatrics & Geriatrics

  • Sinus Infections

  • Insect Bites & Rashes

  • Minor Surgical Procedures

  • School Physicals

  • Annual Physicals

  • Pre-Employment

  • Workman’s Compensation

  • Back Pain

  • Internal Medicine

  • Women’s Health

  • STI Testing

In addition to addressing these immediate medical concerns, Medicare also covers services that urgent care clinics offer:

  • Annual physical examinations,

  • X-rays,

  • Vaccines, and

  • Immunization shots

Coverage Costs To Consider

Understanding the financial aspects of Medicare coverage for urgent care is necessary to avoid any surprises. If you have Original Medicare (Part A and Part B), 80% of the cost for treatment and services received at an urgent care clinic will be paid for by Medicare. However, you must meet the Part B deductible before coverage kicks in. Once the deductible is met, you are responsible for paying the remaining 20% of the Medicare-approved cost.

It's important to note that if you receive care in a hospital outpatient setting, you must also pay a copayment. Medicare Advantage plans, which encompass everything covered by Original Medicare, also cover urgent care visits.

Medicare Coverage for Prescription Drugs

In some cases, an urgent care visit might lead to a prescription for medication to help speed up your recovery. It's important to understand that prescription drug coverage is not included in Original Medicare (Part A and Part B). However, Medicare Part D offers prescription drug coverage as an optional benefit through private insurers.

Securing Reimbursements for Urgent Care Visits

For your urgent care visit to be covered by Medicare, both your local Crimson Care and the healthcare provider treating you must be enrolled in Medicare. It’s highly recommended that you verify this before receiving any services to make sure that you're covered. If either the clinic or the provider isn't enrolled, you'll be responsible for covering the costs out-of-pocket. In such cases, you can file a Medicare reimbursement claim so you can (potentially) get back what you spent.

When filing a reimbursement claim, you'll need to provide the bill from the Crimson Care facility you visited along with a letter explaining your reasons for seeking reimbursement. Keep in mind that the claim must be filed within a year of receiving the services. Medicare Advantage plan holders, on the other hand, do not need to file claims.

For Urgent Care, Visit Your Local Crimson Care in Tuscaloosa, Alabama

If you’re looking for a quick, walk-in primary and urgent care center in Tuscaloosa, Alabama, only Crimson Care can cater to your needs with compassionate and comprehensive services. You’re in good hands with the experienced and caring physicians at Crimson Care.

Drop in for a visit or get in touch with us today at (205) 270-5285. You can also schedule an appointment online.



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