Do Urgent Care Facilities Accept Medicaid?

What do you do if you need to see a doctor but can’t get in with your primary care provider? Emergency rooms are always open, but they are often time-consuming and expensive. If your need is not life-threatening, an urgent care center is an optimal place to receive care. But do urgent care facilities take Medicaid? Read on to find out more about Medicaid coverage of urgent care centers.

Key takeaways:

What is urgent care?

Urgent care is an outpatient treatment center offering medical care for urgent, not life-threatening situations. Urgent care centers provide another means of medical care along with primary care physicians and emergency departments. No appointment is typically necessary, and many are open for extended hours to accommodate patients with unexpected medical needs.

Urgent care can treat illnesses and minor injuries, which can help patients avoid emergency room visits. Urgent care centers do not treat life-threatening illnesses or injuries. Emergency rooms are the best place to receive treatment for those situations.

Is Medicaid accepted at urgent care facilities?

Urgent care coverage by Medicaid depends on where you live and the type of care you receive. Federal Medicaid guidelines state that physician services are covered in every state. Clinic services are an optional benefit each state decides upon. For example, Medicaid through Kaiser is available in eight states and the District of Columbia but only offers coverage for urgent care visits in Georgia and California.

If you live in these states and have Medicaid through Kaiser, you must visit an urgent care facility owned by Kaiser. Additionally, if an urgent care facility is considered a rural health clinic service or a federally qualified health center, it must accept Medicaid.

What other health insurance is accepted at urgent care?

Most health insurance plans are accepted at urgent care clinics. This includes Medicare, Medicaid, and private insurance plans. The deductible, co-pays, and coinsurance amounts will vary based on the insurance plan.

Medicare

Medicare Part B provides coverage for urgent care visits. After the $226 Medicare Part B deductible is met, you will be responsible for 20% of the Medicare-approved amount for urgent care services. There may also be a co-payment associated with your visit.

Private insurance

Most private insurance plans are accepted at urgent care centers. The co-payment amount for an urgent care visit may be higher than for primary care providers. This amount and the coinsurance amount will vary based on the specifics of the insurance plan.

Can urgent care refuse to take insurance?

Although rare, urgent care can refuse to take insurance. They can still provide treatment for your ailment, but you may be required to pay the total upfront if they don't accept your insurance. In these situations, it may be possible for you to file for reimbursement from your insurance company.

The urgent care facility you plan to visit can tell you if they accept your insurance. You can also contact your insurance company to check on urgent care coverage and steps for reimbursement if needed.

What services are covered by Medicaid at urgent care facilities?

Medicaid plans vary by state, so coverage for urgent care centers will also vary. It’s also important to note that not all urgent care facilities offer the same care. If you need medication, x-rays, or lab work, the facility you visit may not offer these services, while others might offer them on-site. Contact your Medicaid provider to learn about coverage for these additional services.

Out-of-pocket costs for Medicaid patients at urgent care

The out-of-pocket costs for Medicaid patients at urgent care will be higher than that of a primary care provider but less than that of an emergency room visit. The cost will also depend on the services provided. Any testing, such as lab work or an x-ray, will increase the total out-of-pocket cost of an urgent care visit.

Deductibles, co-pays, and coinsurance also affect the out-of-pocket cost. Receiving regular care from your primary care provider and following their advice can help you avoid urgent care center visits.

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