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Emergency Rooms and Urgent Care Facilities

Free-Standing Emergency Rooms and Urgent Care Facilities are popping up all over the city. Are you able to go to these facilities on Medicare or Medicare Advantage Plans? Let’s start with defining these facilities.

Free-Standing Emergency Rooms are either privately owned or hospital affiliated. These facilities are fully functioning Emergency Rooms. They are typically open 24 hours a day and are always staffed by an ER physician, a nurse, and a radiologic technologist (imaging studies). They are able to handle most emergencies, but if you require surgery or a higher level of care, they will transport you to the hospital.

Urgent Care Facilities are also privately owned or hospital affiliated. These facilities can also sometimes be found in your local pharmacy or grocery store. These clinics are usually staffed by a physician’s assistant or nurse practitioner. Urgent care facilities are great for coughs, colds, and many minor illnesses. These facilities are lower cost and their level of care is catered towards non-life-threatening illnesses.

If you are on a Medicare Advantage Plan, before going to any of these facilities, look up the name and address of the facility in the directory or call the plan to see if they are in network. If you are on Medicare + Supplement plan, be very careful when you ask if the facility takes Medicare. They may say, “Yes, we take Medicare, but we bill Out-of-Network benefits.” This means they do not truly take Medicare. Check for signs posted on the front door or by the front desk. By law, they must have a posting on whether they accept Medicare or not. These facilities provide great access to care without the long wait times of a traditional Emergency Room, or having to wait weeks to see a Primary Care Provider for the flu or a cough. Before you go to one of these facilities, verify they are in-network, and accept Medicare or are in network with your Medicare Advantage Plan.

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