Urgent care facilities treat a host of illnesses and injuries that aren’t life-threatening but still require immediate medical attention. They are a reasonable alternative to the more expensive and more time-consuming Emergency Room, provided your case is not potentially fatal, even if it is severe.
If you’ve weighed your options and decided that urgent care services are more suited to your medical needs, then the next question that most often comes to mind is: does my health insurance cover this? It can be challenging to lay a finger on the answer to this question, especially if you’re on Medicaid. An understanding of when and how Medicaid covers urgent care services can help you make timely, informed decisions in cases of emergencies.
Does Medicaid allow you to access urgent care services?
The answer is yes.
Most of the time, patients on Medicaid are eligible to visit urgent care facilities for medical assistance. However, while most urgent care facilities will accept Medicaid, not all of them do. This is why it is important to research your insurance plan’s healthcare options and how they serve your needs before an emergency.
Why do some urgent care centers not accept Medicaid?
Your state: Medicaid is a public health insurance plan run by federal and state governments. The federal government provides funding and general regulations, while the states provide rules and requirements specific to their own Medicaid programs. As a result, states can determine if their Medicaid program will cover urgent care or not.
The healthcare provider: Some urgent care centers might refuse to accept Medicaid-insured patients even if the state Medicaid program covers urgent care for reasons such as low reimbursement and administrative hurdles. It is, therefore, crucial for you to make a call in advance to be sure.
How much do you co-pay when on Medicaid?
Your out-of-pocket expenses when on Medicaid depends on your state policy, your Medicaid insurance plan, your insurance company, and whether the urgent care facility is in-network of your Medicaid coverage.
When visiting an urgent care facility, it is important to do your research beforehand by calling your insurance company or visiting the urgent care facility website. This allows you to have an idea of what your out-of-pocket expenses will be and make sure you don’t spend more than necessary.