• Medicaid Urgent Care Copay Plans
• Medicaid Urgent Care Copay Insurance
• Medicaid Urgent Care Copay Plan
• Is Urgent Care Free With Medicaid
• Does Urgent Care Charge A Copay

1. Medicare (Part B) typically covers most urgent care situations
2. There are some out-of-pocket costs that you may have to pay, however.
3. While Medicare Part B covers urgent care and emergency room care, urgent care is typically cheaper and has a shorter waiting time.

• Righttime Medical Care offers urgent care by appointment or walk-in to adults and children, 365 days a year. Righttime has 19 Care Centers throughout Maryland - Annapolis, Arundel Mills (Hanover), Bethesda, Catonsville, Columbia, Frederick, Gaithersburg, Germantown, La Plata, Olney, Pasadena, Pikesville, Potomac, Rockville, Silver Spring, St. Mary's (California), Towson, Waldorf and Waugh.
• Urgent Care facilities can treat a variety of illnesses and conditions without the long wait times and hefty costs that come with visiting the Emergency Room (ER). But where you are able to go for care when you most need it can be difficult to navigate, especially if you are on Medicaid. However, most Urgent Care facilities see patients who have insurance, Medicaid, or need help paying for.
• The copay is usually listed on the health insurance card. The ER copay is usually the highest ($100-500 or more), the Urgent Care copay is usually in the $40-75 range and the PCP copay is usually in the $25-40 range Sometimes you will not find an urgent care copay. However, there will be a specialist copay listed.

The typical copay at urgent care is between $25 and $75, though this depends on your insurance. It’s the insurance company who sets the copay, not the urgent care center. If you’re not sure what your copay is, you can call your insurance provider directly to find out. The only exception to this is if your insurance plan includes co-insurance.

Learn more about the qualifications for Medicare urgent care coverage and how to get help covering some of the additional costs.

Medicare Urgent Care Coverage

Urgent care typically falls under the Medicare coverage category of emergency department services. Medicare Part B covers all emergency department services within the U.S., which includes any service or care provided when you have an injury, sudden illness or condition that worsens very quickly.

Urgent Care Locations vs. Emergency Room Care

Both urgent and emergency room care are covered by Medicare Part B as outpatient care. However, there are several advantages to receiving care at an urgent care center rather than a hospital ER. A visit to the urgent care clinic can often mean:

• Lower costs
• Shorter wait time

Urgent care centers are typically staffed by physicians, physician's assistants and nurses, just like any other doctor's office or ER — the difference is that they aren't equipped to treat life-threatening injuries or illnesses. As long as your injury or illness is non life-threatening, a visit to the urgent care clinic may save you money and time.

Medicare Part A does not cover urgent care clinic visits, but it will help cover some of the costs of inpatient hospital care, lab tests, surgeries and some other costs.

How Does Medicare Pay for Urgent Care Location Visits?

As long as the urgent care center you go to participates in Medicare, your Medicare insurance will typically cover 80 percent of theMedicare-approved cost for services, and you'll pay the remaining 20 percentcoinsurance after you have met your Medicare Part B deductible (which is $203 per year in 2021).

Medicare Advantage and Urgent Care Coverage

Another way to receive Medicare coverage for urgent care is through a Medicare Advantage (Medicare Part C) plan. These plans are sold by private insurers and are required by law to provide all of the same basic benefits as Medicare Part A and Part B.

However, just because an urgent care center accepts Medicare doesn’t mean they will accept all Medicare Advantage plans. Much like more traditional health insurance plans, many Medicare Advantage plans feature networks of doctors, hospitals, pharmacies, medical equipment providers and other types of health care providers including urgent care locations.

Before visiting an urgent care location, check to see that the facility is included in your Medicare Advantage plan network. If they are not a network participant, the visit is not likely to be covered and you may be left responsible paying out of pocket for your care.

While the Medicare Part B deductible and coinsurance amounts are standardized, the costs associated with Medicare Advantage can differ from one particular plan to another. So the cost of your urgent care visit will depend on the terms of your specific plan.

Medicare Supplement and Urgent Care Coverage

Medicaid Urgent Care Copay Plans

Some of the costs of an urgent care visit that's covered by Medicare can be paid for by a Medicare Supplement Insurance (or Medigap) plan. Medigap plans are sold by private insurance companies and provide coverage for Original Medicare deductibles, copayments, coinsurance and other out-of-pocket requirements.

Each type of Medigap plan provides at least some coverage for Part B coinsurance, and eight of the 10 Medigap plans available that are available in most states cover Part B coinsurance costs in full.

Some Medigap plans can also pay for Part B excess charges, which may result when visiting an urgent care clinic that accepts Medicare patients but does not accept the Medicare-approved amount as full payment. These providers are allowed to charge up to 15% more than the Medicare-approved amount.

Medicare Supplement Insurance can help cover your out-of-pocket urgent care costs.

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Overview

Historical information about copayments can be found on the 'Historical' tab

Medicaid Urgent Care Copay Insurance

Information about copayments proposed for members in the Adult Group with income above 106% FPL, subject to approval by the Centers for Medicare and Medicaid Services can be found in the Proposed Copay Changes section of this page. More information will be posted here when available.

* NOTE: Copays under this section are copays charged under Medicaid (AHCCCS). This section does not describe copay requirements under Medicare.

Some people who get AHCCCS Medicaid benefits are asked to pay copays for some of the AHCCCS medical services that they receive. Copays can be mandatory (also known as required) or optional (also known as nominal) as explained below. Some people and certain services are exempt from copays which means that no mandatory or optional copays will be charged as explained below.

Copays are not charged to the following persons:

• People under age 19
• People determined to be Seriously Mentally Ill (SMI) by the Arizona Department of Health Services
• Individuals up through age 20 eligible to receive services from the Children's Rehabilitative Services program
• People who are acute care members and who are residing in nursing homes, or residential facilities such as an Assisted Living Home and only when the acute care member’s medical condition would otherwise require hospitalization. The exemption from copays for acute care members is limited to 90 days in a contract year
• People who are enrolled in the Arizona Long Term Care System (ALTCS)
• People who are Qualified Medicare Beneficiaries
• People who receive hospice care
• American Indian members who are active or previous users of the Indian Health Service, tribal health programs operated under P.L. 93-638, or urban Indian health programs
• People in the Breast & Cervical Cancer Treatment Program
• People receiving child welfare services under Title IV-B on the basis of being a child in foster care or receiving adoption or foster care assistance under Title IV-E regardless of age.
• People who are pregnant and throughout the postpartum period following the pregnancy
• People in the Adult Group (for a limited time*)

*For a limited time persons who are eligible in the Adult Group will not have any copays. Members in the Adult Group include persons who were transitioned from the AHCCCS Care program as well as individuals who are between the ages of 19-64, and who are not entitled to Medicare, and who are not pregnant, and who have income at or below 133% of the Federal Poverty Level (FPL) and who are not AHCCCS eligible under any other category. Copays for persons in the Adult Group with income over 106% FPL are planned and can be found on the Proposed Copay Changes tab. Members will be told about any changes in copays before they happen.

In addition, copays are not charged for the following services for anyone:

• Hospitalizations
• Emergency services
• Family Planning services and supplies
• Pregnancy related health care and health care for any other medical condition that may complicate the pregnancy, including tobacco cessation treatment for pregnant women
• Well visits and preventive services such as pap smears, colonoscopies, and immunizations
• Services paid on a fee-for-service basis
• Provider preventable services
• Services received in the emergency department

People with Nominal (Optional) Copays

Individuals eligible for AHCCCS through any of the programs below may be charged nominal copays, unless they are receiving one of the services above that cannot be charged a copay or unless they are in one of the groups above that cannot be charged a copay. Nominal copays are also called optional copays. If a member has a nominal copay, then a provider cannot deny the service if the member states that s/he is unable to pay the copay. Members in the following programs may be charged nominal copays unless they are receiving one of the services above that cannot be charged a copay or unless they are in one of the groups above that cannot be charged a copay. Members in the following programs may be charged a nominal copay by their provider:

• State Adoption Assistance for Special Needs Children who are being adopted
• Receiving Supplemental Security Income (SSI) through the Social Security Administration for people who are age 65 or older, blind or disabled
• SSI Medical Assistance Only (SSI MAO) for individuals who are age 65 or older, blind or disabled

Ask your provider to look up your eligibility to find out what copays you may have. You can also find out by calling your health plan member services representative. You can also check your health plan's website for more information.

AHCCCS members with nominal copays may be asked to pay the following nominal copays for medical services:

Detailed service codes and category description that comprise each of the above categories are outlined on the attached Document

Medical providers will ask you to pay these amounts but will NOT refuse you services if you are unable to pay. If you cannot afford your copay, tell your medical provider you are unable to pay these amounts so you will not be refused services.

Some AHCCCS members have required (or mandatory) copays unless they are receiving one of the services above that cannot be charged a copay or unless they are in one of the groups above that cannot be charged a copay. Members with required copays will need to pay the copays in order to get the services. Providers can refuse services to these members if they do not pay the mandatory copays. Mandatory copays are charged to persons in Families with Children that are no Longer Eligible Due to Earnings - also known as Transitional Medical Assistance (TMA)

Adults on TMA have to pay required (or mandatory) copays for some medical services. If you are on the TMA Program now or if you become eligible to receive TMA benefits later, the notice from DES or AHCCCS will tell you so. Copays for TMA members are listed below.

Detailed service codes and category description that comprise each of the above categories are outlined on the attached Document

Medicaid Urgent Care Copay Plan

The amount of total copays can not be more than 5% of the family’s total income during a calendar quarter (January-March, April-June, July-September, and October-December). If this 5% limit is reached, no more copays will be charged for the rest of that quarter. AHCCCS has a process to track cost sharing. If a member thinks that the total copays they have paid are more than 5% of the family's total quarterly income and AHCCCS has not already told them, the member should send copies of receipts or other proof of how much they have paid to:

Is Urgent Care Free With Medicaid

AHCCCS
801 E. Jefferson
Mail Drop 4600
Phoenix, Arizona 85034

If a member’s income or circumstances have changed, it is important to contact the eligibility office right away.

Does Urgent Care Charge A Copay

NOTE: The information posted on this webpage describing proposed copays is being updated. AHCCCS is working with CMS to revise the State Plan Amendment for copays that AHCCCS plans to charge members in the future. This webpage, and the link to the revised State Plan Amendment, will include the updated changes to copays when they become available. AHCCCS will also provide additional public notice of the changes to copays that AHCCCS will be proposing to charge members.