Emergency Care and Urgent Care
Your plan’s rules and costs may differ for some types of care. Knowing these rules can help you control your costs and get the right care in the right setting.
- Emergency care. Many plans cover some part of the cost of emergency care for sudden, serious sicknesses or injuries. They may cover emergency care even if you are outside the plan’s network. Once your condition is stable, you will often be moved to a doctor or hospital in your plan’s network for further care.
You will often pay a copay, which is sometimes waived if you are admitted to the hospital. Keep in mind that most plans only cover visits to the emergency room (ER) for “true” emergencies. If you visit the ER for non-emergency care, you could have high out-of-pocket costs.
- Urgent care. When you need care quickly for an illness or injury that is not a “true emergency,” you can visit an urgent care center. These centers offer care after hours and on weekends, when your family doctor may not be available. But, they are not equipped to deal with major traumas or health problems.
Most health plans have urgent care centers in their networks. Your copay or coinsurance for an urgent care visit will often be lower than for an ER visit.
- In a serious emergency or one that threatens your life, seek care first. Call your insurer once your health problem is stable.
- Many insurers have 24-hour helplines for members. If you’re not sure whether to go to the ER or some other setting, call and ask.
- Visit your plan’s website to find urgent care centers in your network.
It can be frightening when a sudden illness or injury strikes, especially if your regular doctor is not available. You need to make a choice quickly about where to get the medical attention you need. But, it’s also important to have all the facts before you seek care.
|Urgent Care Center Routine Care||Emergency Room Routine Care|
|Your Plan Pays||$280 ($300 - $20)||$0|
|You will owe||$20||$1,000|