Understanding Medicare and Urgent Care: What Patients Need to Know

The popularity of urgent care centers continues to grow, in large part due to their convenient locations, extended hours, lower costs, and shorter waiting periods. It’s no wonder that more Americans are choosing to go to urgent care instead of their physician’s office or the emergency room.
It’s not just a general perception of faster, more affordable care. Data backs all of this up. In fact, a recent study found that patients located in large metro areas may have to wait up to 24 days to schedule an appointment with their physician. That means you could be in need of care for more than three weeks before you’re ever seen by your doctor. In contrast, 60% of all walk-in urgent care facilities have wait times of less than 15 minutes. In terms of quick care, that’s an easy decision to make.

Plus, urgent care facilities often provide the same level of care in non-life-threatening situations; a Milliman study found that 65% of all emergency room cases could have been treated in urgent care centers. Ultimately, that means patients could have received equivalent care in less stressful environments, often for a lot less money. Case in point: on average, a medical situation handled in the ER costs $2,039, but the same situation treated in an urgent care center would cost approximately $226.

But it’s important to note that Medicare patients need to do their research before opting for urgent care treatment. Around 75% of Medicare beneficiaries take advantage of the medical and other services available to them each year. While patients with Medicare insurance would undoubtedly benefit from the fast, high-quality, and affordable treatment options urgent care can provide, it’s unfortunately not an option in many cases.

A lot of people believe that the medical providers in question (in this case, the urgent care facility) decide whether to accept Medicare insurance and offer discounted rates to patients. But that’s actually not true. The Centers for Medicare and Medicaid Services (CMS) is responsible for approving and rejecting medical facilities, like urgent care centers, to determine whether or not they can accept Medicare and be reimbursed for those healthcare costs. Sadly, CMS rejects many urgent care facilities during this process and makes it impossible for them to provide discounted treatment rates to Medicare patients.

While there are some urgent care centers that are able to make costs more affordable to Medicare patients, that’s not always the case. It’s important to do your research and make certain that a given medical provider will not only accept your insurance but will provide you with a discounted rate due to an established relationship with your insurer. Considering that there are currently 44 million people enrolled in the Medicare program and projected enrollment is set to reach 79 million by 2030, it will become increasingly important for seniors to be able to find affordable and accessible medical care.

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