For regular medical treatment, you know what to do. Just call your primary care physician and schedule an appointment. If you’re injured or feel suddenly ill outside of standard business hours, though, do you know what to do? What’s the difference between the ER and urgent care? And what does Medicare cover? In this post, we compare ER vs urgent care and discuss the types of care available at each facility.
What’s the Difference Between an Emergency Room and an Urgent Care Center?
While both emergency rooms and urgent care centers offer acute care, there are differences between the two. Generally speaking, it comes down to the level of care available at each.
Urgent care centers, also known as walk-in clinics, are equipped to handle sudden illness or minor injuries. If you have a sudden illness or minor injury and your regular doctor can’t fit you in, you can go to an urgent care center. Emergency room visits are for threats to life-and-limb. The ER is designed to handle complex and/or critical medical needs.
When Should You Go to the Emergency Room?
If your issue requires fast or advanced treatment, and you reasonably believe yourself to be in danger of losing life or limb, go to the emergency room. Or, to put it another way, if you even for a moment considered calling 911, you probably need the ER, not urgent care. In fact, most of the time, if you go to an urgent care center with potentially life-threatening symptoms, they’ll send you to the emergency room.
Any of the following symptoms likely warrant an ER visit:
Much of it comes down to instinct, though. If your gut tells you that it’s time to get to the emergency room, listen to that instinct.
When Should You Go to Urgent Care?
One way to determine when you should go to urgent care instead of the ER is to answer this question: Would you feel comfortable seeing your regular doctor to treat the issue? If the answer is Yes, an urgent care center is probably fine.
Minor illnesses and injuries are best handled in an urgent care center. For one thing, wait times are typically much shorter at urgent care. Patients are seen according to severity of their issue at an ER. If your situation isn’t life-threatening, you fall way down on the list compared to the true emergency cases.
Go to urgent care if you have any of the following symptoms and your regular doctor can’t fit you in:
Again, if you can get in to see your primary care physician, that should be your first choice. Just as ERs see patients according to the severity of their condition, so do urgent care centers.
When Should You Call 911?
If you aren’t unconscious, it can feel a little surreal to make the choice to call 911 instead of driving yourself to the emergency room. However, sometimes, that’s exactly what you need to do.
There are times when driving yourself presents a significant danger to both yourself and anyone sharing the road with you. If you feel faint, are bleeding severely, have impaired vision, or severe chest pain, always call 911. Not only will the ambulance driver get you to the emergency room safely, the paramedics will begin life-saving procedures (if necessary). For many critical medical issues, speed of treatment is a key factor in making a successful recovery.
Does Medicare Coverage Urgent Care?
Medicare Part B covers “urgently needed care” for non-emergency medical needs. Most urgent care centers accept Medicare, but not all do. Before receiving treatment, verify which clinics in your area accept Medicare insurance.
Your cost under Part B is 20 percent of the Medicare-approved amount for provider services. If you receive outpatient hospital treatment, the hospital copayment applies.
Medicare Advantage plans must cover urgent care received anywhere in the United States, with no additional coverage rules or costs to the beneficiary.
What Emergency Care Does Medicare Cover?
Medicare Part B covers emergency services in the event of sudden illness, injury, or an existing illness that suddenly gets much worse. You have a copay for each emergency department you visit and hospital service you receive. There is also the standard copay of 20 percent of the Medicare-approved amount for any doctor services received.
If you are admitted to the hospital within three days of your ER visit for a related condition, you do not have the Part B copayment. This is because your ER visit is considered part of your hospital admission.
Your Part B insurance also covers ambulance transportation if deemed medically necessary. For full details on Medicare’s ER coverage and your costs, please review their Emergency Department page.
As always, if you have any questions regarding your Medicare coverage, call us toll-free at 855-350-8101. One of our licensed agents can answer any questions you have.