Does your health plan cover urgent care visits?

Does your health plan cover urgent care visits? 150 150 Tony Guo

Does your health plan cover urgent care visits?

Some health plans, especially plans that don’t include out-of-network benefits, only cover office visits to primary care physicians and specialists. If you see a doctor who isn’t part of your plan’s network, you could face hefty copayments (e.g., $100 per visit) or even uncovered charges on top of that amount.

Many health plans only cover urgent care visits for injuries sustained in an accident. To make sure you’re covered, read your insurance plan or visit your plan’s website to learn more about what’s covered and what isn’t. If you aren’t sure if your health plan covers urgent care at all, check with them directly before paying out of pocket. You should also ask whether they offer a discount if you go to certain urgent care clinics in their network. In some cases, if you have a certain type of high-deductible health plan (HDHP), using an urgent care clinic as opposed to going to your doctor will save you money on copays, coinsurance and deductibles.

Unless you have an Obamacare health plan, urgent care visits are likely to be out-of-pocket. Depending on your policy, you may end up paying $80 or more per visit. If that’s not a concern for you, then there’s no reason to worry about going to urgent care. But if it is a big deal, then make sure you check your policy carefully and contact your insurance company before visiting one so you know exactly what’s covered and what isn’t. Many times plans will have co-pays for certain services like X-rays or office visits—it’s important to ask about those in advance so as not to get blindsided by surprise costs.

If you’re under 65, odds are that urgent care visits won’t be covered by your health insurance. Check your plan to be sure—or ask your doctor or employer if they have a preferred urgent care practice in their network. Another option is to bring cash, since many urgent care practices accept both credit cards and cash (and some even offer discounts for paying with cash). One more tip: If you’re using a health savings account card (HSA), check with your provider to see if it will reimburse you for co-pays on urgent care visits, but keep in mind that not all HSA cards are accepted at all practices.

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