Yes, most urgent care centers accept Medicare, but not all do — and coverage depends on whether the facility is in your plan's network
Medicare covers urgent care visits at facilities that are enrolled as Medicare providers. However, you will pay different amounts depending on whether you go to an in-network or out-of-network center, and some urgent care clinics do not accept Medicare at all. Before you go, it is worth calling ahead to confirm the center takes your specific Medicare plan and to understand what you will owe.
Urgent care is different from an emergency room visit. Medicare treats urgent care as an outpatient service, similar to a doctor's office visit. You will typically pay a copay (usually $15 to $50) if you have Original Medicare with a Medigap or Part D plan, or a copay or coinsurance if you have a Medicare Advantage plan. The exact amount depends on your plan and whether the center is in your network.
Key Takeaways
- Call the urgent care center before you go to confirm it accepts your specific Medicare plan and ask what your copay will be.
- In-network urgent care centers cost less than out-of-network ones, and some out-of-network visits may not be covered at all.
- Medicare covers urgent care as an outpatient service, not an emergency room visit, so costs are lower than the ER.
- If you have a Medicare Advantage plan, check your plan's provider directory or call the plan directly to find in-network urgent care near you.
- Bring your Medicare card and any other insurance cards when you go, so the center can bill correctly.
How Medicare covers urgent care visits
Original Medicare (Part A and Part B) covers urgent care at any facility that is enrolled as a Medicare provider, as long as the visit is medically necessary. You will pay 20% of the Medicare-approved amount for the visit after you meet your Part B deductible (which is $240 in 2024, though this amount changes yearly). If you have a Medigap policy, it usually covers some or all of that 20% coinsurance, so your out-of-pocket cost may be just a copay or nothing at all.
Medicare Advantage plans (Part C) work differently. These plans set their own copays and coinsurance amounts, and they require you to use in-network providers in most cases. If you go to an out-of-network urgent care center, you may pay more or the visit may not be covered. Your plan's provider directory lists which urgent care centers are in your network, or you can call your plan's customer service number to find one near you.
In-network versus out-of-network urgent care
An in-network urgent care center has a contract with Medicare or your Medicare Advantage plan to accept a set payment amount. You pay only your copay or coinsurance, and the center bills your insurance for the rest. This is the most affordable option and the one you should aim for.
An out-of-network center does not have a contract with your plan. If you go there, you may have to pay the full bill upfront and then request reimbursement from Medicare, or you may be responsible for the difference between what the center charges and what Medicare pays. With Original Medicare, you can still use an out-of-network provider, but you will pay more. With Medicare Advantage, out-of-network care is often not covered except in true emergencies.
The safest approach is to call ahead and ask: "Is this center in-network for [your plan name]?" If the answer is no, ask whether Medicare will cover the visit and what you will owe.
What to bring and what to expect
Bring your Medicare card and your insurance card (Medigap or Medicare Advantage) when you go. The urgent care center will ask for these at check-in so they can verify your coverage and bill correctly. If you have a secondary insurance policy, bring that card too.
When you arrive, the center will likely ask you to fill out a form with your medical history and the reason for your visit. Tell the staff about any medications you take and any allergies. The visit itself usually takes 30 minutes to an hour, depending on how busy the center is and what needs to be done.
After the visit, the center will send a bill to Medicare and your insurance. You will receive an explanation of benefits (EOB) in the mail that shows what Medicare paid, what your insurance paid, and what you owe. If you have questions about the bill, call the urgent care center's billing department or your insurance plan.
When to use urgent care instead of the emergency room
Urgent care is meant for problems that need attention soon but are not life-threatening. Examples include minor cuts or burns, sprains, mild infections, chest pain that is not severe, and shortness of breath that started recently. Urgent care centers can usually handle these issues faster and at lower cost than an emergency room.
Go to the emergency room instead if you have chest pain with pressure or shortness of breath, signs of stroke (face drooping, arm weakness, speech difficulty), severe bleeding, difficulty breathing, or any other symptom that feels like a medical emergency. Call 911 if you are unsure or if the problem is getting worse.
Medicare covers emergency room visits in full (after your deductible) if the visit is truly for an emergency. However, if the ER determines your problem was not an emergency, you may be billed as if you had gone to urgent care instead, so costs can vary.
Finding an urgent care center that takes Medicare
If you have Original Medicare, you can go to any urgent care center that is a Medicare provider. To find one, search online for "urgent care near me" and call to ask if they accept Medicare. You can also ask your primary care doctor for a recommendation.
If you have a Medicare Advantage plan, use your plan's provider directory (usually available on the plan's website or by calling customer service) to find in-network urgent care centers. Searching online for "urgent care near me" will also show you centers in your area, but you will need to verify with your plan that they are in-network before you go.
Some urgent care centers are part of large chains (like CVS MinuteClinic or Walgreens urgent care), while others are independent. Chain locations are more likely to accept Medicare, but always call ahead to confirm.
What to ask before you go
Call the urgent care center and ask these questions:
- Do you accept Medicare?
- Are you in-network for my plan? (Give the plan name.)
- What is my copay or coinsurance for an urgent care visit?
- Do I need to schedule an appointment, or do you take walk-ins?
- What are your hours?
- What should I bring with me?
If the center does not accept Medicare or is out-of-network and you do not want to pay extra, ask your doctor's office if they can see you the same day or the next day, or search for another urgent care center nearby.
Frequently Asked Questions
Will Medicare cover an urgent care visit on a weekend or holiday?
Yes, Medicare covers urgent care visits any day of the week, as long as the center is a Medicare provider and the visit is medically necessary. You will pay the same copay or coinsurance as you would on a weekday. Some urgent care centers charge extra for weekend or holiday visits, so ask about this when you call.
What if the urgent care center says I should have gone to the ER instead?
If the center determines your problem was not urgent and refers you to the ER, Medicare will still cover the urgent care visit itself. However, if you then go to the ER and it also determines the problem was not an emergency, you may be billed at the urgent care rate rather than the ER rate. Ask the urgent care center to explain their recommendation before you leave.
Can I use urgent care if I have both Medicare and Medicaid?
Yes. When you have both Medicare and Medicaid (called "dual may be able to access"), Medicare is your primary insurance and Medicaid is secondary. Give both cards to the urgent care center at check-in so they can bill in the correct order. Your copay will be based on your Medicare plan.
Do I need a referral from my doctor to go to urgent care?
No. Medicare does not require a referral for urgent care visits, even if you have a Medicare Advantage plan. You can go directly to an in-network urgent care center without asking your doctor first. However, telling your doctor about the visit afterward is a good idea so they have a complete record of your care.
What happens if I go to an urgent care center that is not in my network?
With Original Medicare, you can still use an out-of-network center, but you will pay 20% coinsurance instead of a copay, and you may have to pay upfront and request reimbursement. With Medicare Advantage, out-of-network urgent care is usually not covered unless it is a true emergency. Call your plan before you go to an out-of-network center to understand what you will owe.