Does Insurance Cover Urgent Care? What You Should Know Know Before Your Visit
10 Minutes
Team Curative
May 16, 2022
If you need to visit an urgent care center, you may be wondering "is urgent care covered by insurance?" The last thing you want on your mind is worrying about costs. But the truth is that uninsured emergency care can sometimes get quite expensive. With uninsured ambulance rides sometimes costing up to $20,000 per ride, it’s wise to take a few minutes to understand what you’ll pay whenever you’re in an emergency healthcare situation.
This page answers the question “Is urgent care covered by insurance?” and provides an overview of exactly how much you can expect to pay (or not pay) depending on your insurance status in particular.
By the time you’re done reading, you’ll be equipped with all of the information you need to visit an urgent care center without the added stress of going into a financially unknown situation.
In the future, be sure to work with an insurance company that makes it easy for you to understand what you’re covered for with just a few clicks. A convenient digital-first approach to managing and accessing your plan means you can get the healthcare services you need, faster, without additional concerns or stress.
What’s the Difference Between Walk-in Clinics, Urgent Care Centers, and the Emergency Room?
Before you visit an urgent care center, the first thing you want to do is make sure that it makes sense for you to visit an urgent care center. Urgent care centers are not the only way for you to receive immediate medical attention. Three options are available to you: walk-in clinics, urgent care centers, and the emergency room.
Walk-in Clinics
To visit a traditional primary care physician, you almost always need to book an appointment in advance. Depending on your location and how busy the office of your primary care physician is, you may need to wait weeks before you can see someone.
Walk-in clinics are different in that no appointment is required. You simply “walk into” the clinic and receive care right away. Depending on how busy the clinic is, you may need to wait up to a few hours, but walk-in clinics are almost always a significantly faster option over a traditional medical office.
It makes sense to visit a walk-in clinic if you have a minor medical problem that is not life threatening or overly serious, such as a persistent cough or treating a minor injury to ensure it doesn’t get infected.
If your problem is too severe, a walk-in clinic may refer you to an urgent care center.
Walk-in clinics are also an ideal place to get a physical examination or a more specific type of health screening, such as one to test cholesterol levels.
Urgent Care Centers
An urgent care center has everything that a walk-in clinic has, except urgent care centers are also able to provide treatment for more serious medical problems. For example, an urgent care center can frequently provide treatment for a broken bone in the hand, wrist, ankle, or foot, whereas a walk-in clinic would not be able to do the same.
Unlike walk-in clinics, which are frequently staffed with only nurse practitioners and physician assistants, urgent care centers will frequently have at least one doctor ready to see patients during business hours. Along with better equipment, this improved level of staffing also allows urgent care centers to treat a wider range of medical problems than walk-in clinics.
When Should I Go to the Emergency Room Instead of an Urgent Care Center?
It’s possible you’re asking the question “Does insurance cover urgent care visits?” because you’re concerned about the high costs of emergency room visits, especially without health insurance coverage.
When it comes to deciding on an urgent care center or the emergency room, it’s a simple question: Is your medical problem life-threatening?
If it is, you need to go to the emergency room, where it’s guaranteed you’ll have all necessary medical equipment and staff on standby to treat your problem.
If your problem is less severe, you may be able to go to an urgent care center and potentially save money. A recent study found that two-thirds of 27 million emergency room visits were “avoidable” and “not an actual emergency”.
How Much Cheaper Is Urgent Care Than the Emergency Room?
Emergency room visits can be very expensive, even if you receive minimal treatment while you’re there. The same recent study found that the average cost for an ER visit was over $2,000, even if the patient came in with an avoidable problem that was not a real emergency.
Urgent care visits, on the other hand, are usually significantly more affordable, with the average cost being $193, without insurance.
Therefore, if you’re not in a life-threatening situation, it does make sense to consider going to an urgent care center over the emergency room. At the same time, if you know you are experiencing a serious medical problem, don’t risk it. Go straight to the emergency room. Urgent care centers will usually refer you to the emergency room if your problem is too serious, anyways.
How Much is an Urgent Care Visit Without Insurance?
How much does urgent care cost without health insurance? As covered in the section above, without health insurance, the average cost of a visit to an urgent care center is $193.
Your fee may be higher or lower depending on where you live. For example, areas with higher costs of living will also usually have higher fees for urgent care center visits.
Keep in mind that this fee is usually just for the visit and does not always include additional services beyond the initial consultation. For example, if you need to get many different tests performed to check for certain diseases or ailments, your costs may end up being higher.
Does My Insurance Plan Cover Urgent Care Visits?
If you're wondering how urgent care works with insurance, it's important to know that the Affordable Care Act (ACA), passed in 2010, requires compliant healthcare plans to provide coverage for emergency services, even if the hospital isn’t in the approved medical network (explained more in the section below).
However, some plans differentiate between emergency services and urgent care, and have different fees for the two different types of healthcare facility. So, if you're wondering how does urgent care work with insurance, it's crucial to check the details of your plan to determine whether you're covered.
This different classification usually works to your advantage. For both the emergency room and an urgent care center, you will almost always be responsible for a copay: a flat fee you pay to access the particular healthcare service. In plans that differentiate between emergency room care and urgent care centers, such as workplace-sponsored health insurance plans, the copay for an urgent care center visit is usually substantially cheaper.
Can I Visit Any Urgent Care Center I Want to?
Technically, you can visit any urgent care center you want to. As long as you can pay for your visit, you won’t be turned away.
That being said, you may want to carefully select the urgent care center you end up visiting due to how your insurance plan works. Many types of plans will put restrictions on which urgent care centers you can go to. If you go outside of this approved network of urgent care centers, you may receive only partial coverage, or even no coverage at all like in the case of teeth whitening.
For example, one of the most popular types of insurance plan is an HMO (Health Maintenance Organization). HMOs are attractive options thanks to their low monthly premiums. However, they’re also very restrictive— for emergency but non-life-threatening medical situations, if you receive healthcare services from an urgent care center outside of the approved network, you could be on the hook for the entire bill.
When in doubt, call your insurance company and/or urgent care centers in your area to confirm that your insurance plan will provide coverage for you to receive healthcare services at that location.
Which Mistakes Should You Avoid When Going to an Urgent Care Clinic?
With a little bit of preparation, you can make sure your visit goes smoothly and you don’t encounter any unwanted surprises, financial or otherwise.
Is It Actually an Urgent Care Center?
Some urgent care centers look like urgent care centers, and they may even have the words “urgent” and “care” somewhere on their signage—but because they’re equipped as robustly as an emergency room is, they actually charge emergency room rates.
These surprise fees can be a big deal for two reasons: you may need to pay a substantially higher copay than you were expecting, and in worst-case situations, you could be on the line for a much higher portion of the bill if your insurance plan has different rules regarding emergency room visits versus urgent care visits.
Emergency room visit costs can quickly spiral out of control without insurance, so along with confirming an urgent care center is within your approved medical network, also be sure to confirm it bills as an urgent care center and not an emergency room.
Downplaying the Severity of Your Problem
Because urgent care center visits are often significantly less expensive than emergency room visits, it’s tempting to want to avoid the emergency room. And in cases where your life is not immediately in danger, avoiding the emergency room can be a financially pragmatic decision.
However, always be honest with yourself regarding the severity of your problem. If you need advanced medical attention, you need to go to the emergency room to ensure you receive immediate care from the right specialists who have all of the equipment they need—even if it does end up being expensive.
Getting an Appointment Just for a Prescription
If you have a good relationship with your primary care physician, you can sometimes call their office, even after hours, and describe the symptoms you’re having. If your doctor deems it appropriate, they may write you a prescription based on your description of your symptoms alone, then have you come in for a followup visit as soon as possible.
This approach to getting a prescription can save you a visit to the urgent care center and therefore eliminate the need for the copay you’d be responsible for.
Forgetting to Confirm Coverage Beforehand
Even if you have a serious medical problem, insurance companies generally are not able to give a lot of leeway with coverage if you venture outside of the approved medical network of your insurance plan.
Regardless of whether or not you have a serious medical problem right this instant, it may make sense to note which urgent care centers you can visit now, so that in the future, if something does happen, you can just drive to one where you know you’ll receive coverage—instead of needing to verify coverage during a difficult time.
Which Are the Types of Private and Public Insurance Plans for Urgent Care?
Like psychiatry, almost every type of private insurance plan will provide at least some coverage for urgent care visits. Learn more about popular types of insurance plans to see which restrictions your plan might have.
Public insurance plans also usually cover urgent care visits. The two most popular types of public healthcare plans in the United States are Medicare and Medicaid.
Can I Use Medicaid at an Urgent Care Clinic?
Yes. Most urgent care clinics accept Medicaid. Like with private health insurance plans, you may be responsible for a small copay under Medicaid when you visit an urgent care center.
Be sure to verify beforehand that Medicaid is accepted at the urgent care clinic you wish to visit.
Can I Use Medicare at an Urgent Care Clinic?
Yes. If you have met your part B deductible, Medicare will pay for the majority of your urgent care visit via a coinsurance structure: they pay 80% and you pay 20%.
As with Medicaid, be sure to verify beforehand that Medicare is accepted at the urgent care clinic you wish to visit.
Summary
Does health insurance cover urgent care? In almost all cases, the answer is yes. With private insurance, you will likely be responsible for just a copay, assuming all services (such as testing) and products (such as prescription pills) you end up needing are covered under your plan.
Before you visit an urgent care center, check with the urgent care center and your insurance company to make sure you can receive coverage at whichever specific urgent care center you plan to visit. Some insurance plans will provide coverage only if you visit certain in-network urgent care centers, and provide partial or no coverage if you venture outside of this approved network.
If you need medical attention immediately due to a severe medical concern, go to the emergency room. Although urgent care centers can help treat somewhat serious problems, they should not be seen as a substitute for emergency rooms, which are fully-equipped with everything that is needed for life-or-death situations.
In the future, be sure to work with an insurance company that makes it easy for you to understand what you’re covered for with just a few clicks. A convenient digital-first approach to managing and accessing your new health insurance plan means you can get the healthcare services you need, faster, without additional concerns or stress.
