What should you do when you can’t make it to a doctor’s office during a minor medical emergency? Urgent care centers often provide the answer. While they don’t handle life-threatening conditions, they are equipped to treat a wide range of common ailments, from colds and flu to fractures and even asthma attacks.
Some urgent care facilities offer services like vaccinations, x-rays, and lab tests. This is a valuable resource for those seeking minor medical attention. But does insurance cover urgent care, or is it an out-of-pocket expense? And does the type of health plan you have make a difference?
These are crucial questions to answer before heading to your nearest urgent care center. So, let’s explore whether urgent care is typically covered by insurance.

Does Urgent Care Accept Insurance?

Most urgent care centers around the country are privately owned, but the good news is that they usually accept all major health insurance plans. However, whether your specific treatment is covered depends on the terms and conditions of your particular insurance policy and its tier level.

Health insurance coverage varies, and different providers offer different types of plans. Some insurance plans only cover medical emergencies, while others are more comprehensive, including treatments provided by urgent care facilities. Additionally, health insurance coverage can differ from state to state. It’s vital to review the terms of your specific policy before seeking treatment or visiting an urgent care center.

Most popular health insurance plans, such as Aetna, Anthem, and UnitedHealthcare, are accepted at the majority of urgent care facilities. To avoid unpleasant surprises, especially when going to an unfamiliar urgent care center or one out of state, it’s advisable to call ahead and confirm whether your health insurance plan is accepted.

Co-Pays & Co-Insurance.

Regardless of your insurance plan, you’ll likely be responsible for some form of copayment or coinsurance at an urgent care facility.

• A copayment (or copay) is a fixed amount you pay for services and prescriptions at medical facilities, including urgent care.
• Coinsurance is a percentage of medical costs you’ll need to cover after reaching your deductible, with your insurance covering the remainder.
• Your deductible is the amount you must pay for medical costs out of pocket before your insurance starts sharing the expenses.

The exact copayment or coinsurance amount may vary depending on your insurance plan, but typically ranges from $20 to $40, even with insurance. For extensive tests, these costs can be higher.
Coverage for services like X-rays, lab tests, and vaccinations may not be the same on every insurance plan, and additional out-of-pocket expenses might be required.

Does Urgent Care Accept Medicare?

Urgent care centers do accept Medicare, but it’s essential to recognize that not all urgent care centers are alike. Similar to various health insurance providers and plans, urgent care facilities differ across the United States.

While most urgent care providers accept Medicare, having health insurance is not a requirement for treatment. However, coverage is typically determined by the specific Medicare plan you have, rather than the facility itself. Urgent care centers focus on non-emergency medical situations, excluding life-threatening conditions.

Medicare covers urgent care, but if you have Medicare Part B, you’ll typically be responsible for paying 20% of the Medicare-approved amount. There may also be a deductible for Medicare Part B. Additional tests and care may come with extra costs.

What Does Insurance Cover at Urgent Care Clinics?

The coverage you receive at urgent care centers depends on your health insurance plan. Your coverage might also be subject to a deductible or require a copayment.

In general, most general consultations and treatments for minor ailments are covered. Some examples of conditions treated at urgent care facilities include:

• Allergic reactions
• Colds and flu with symptoms like a sore throat and fever
• Sinus infections
• Eye infections
• Dental issues and pain
• Headaches and migraines
• Back pain
• Skin rashes
• Muscle sprains and strains
• Cuts and burns

While some urgent care centers may offer additional services like lab tests, EKG testing, or X-rays, you might need to pay extra for these services.

What If You Can’t Afford the Costs?

For individuals without health insurance or those whose insurance doesn’t cover their treatment, some urgent care centers offer payment plans. However, these plans are at the discretion of the facility and are not guaranteed at all urgent care centers.

Obtaining affordable health insurance is the most effective way to safeguard against such situations. Subsidized health insurance plans cater to low-income and even no-income households, providing accessible coverage.

Distinguishing Between Urgent Care Centers and Emergency Rooms

Several differences exist between urgent care centers and emergency rooms:

• Urgent care centers offer short-term treatment for non-life-threatening conditions, while emergency rooms handle potentially life-threatening situations.
• Emergency rooms often have longer wait times due to the high volume of medical complaints, while urgent care centers typically have shorter or minimal wait times.
• Urgent care centers have varying operating hours, whereas emergency rooms are open 24/7.
• For those without insurance, urgent care services require out-of-pocket payments, whereas hospital emergency rooms provide treatment regardless of the ability to pay, with all ACA subsidized insurance plans automatically covering emergency room treatments.

Choosing Between Private and Subsidized Health Insurance at Urgent Care Centers

In general, the coverage you receive at urgent care centers is similar, whether you have private or subsidized health insurance. Private health insurance plans might offer more options, such as the ability to choose your doctor and potentially shorter wait times at facilities like emergency rooms and urgent care centers.

The choice between subsidized and private health insurance largely depends on your specific needs and preferences. Some subsidized health insurance plans provide comprehensive coverage as well.

Frequently Asked Questions About Urgent Care

• Are urgent care clinics more expensive than private doctor consultations?: Urgent care centers are typically not more expensive than private doctor visits, making them a preferred choice for uninsured individuals.
• Do urgent care clinics offer ante-natal and reproductive health services?: Some urgent care centers provide reproductive health services, including STD testing, pregnancy tests, and ultrasound scans. Community sexual health clinics may also offer these services.
• Will urgent care clinics treat undocumented immigrants or migrant workers?: Urgent care centers can provide care to undocumented immigrants, but they may need to pay out of pocket unless they have private health insurance. Certain exceptions apply in California.
• Do you need to book an appointment to go to urgent care?: Urgent care centers typically accept walk-ins, although you may experience some wait time. Some centers may offer appointment options or online waiting lists for added convenience.

Conclusion

Urgent care clinics can offer a more affordable alternative to doctor’s office visits, although costs can add up, especially without insurance. Most urgent care centers accept various types of health insurance, making it a wise choice to secure coverage. At Enhance Health, we assist you in comparing health plans to find the one that suits your needs. If you have a low income or no income at all, we can provide guidance on subsidized plans available through the marketplace.