Urgent Care vs. Emergency Room? Which to Choose?

You or a family member may experience an accident or illness and need to see a doctor quickly for treatment. Your decision on where you go for care can impact your health and your wallet.  Emergency Room visits are typically more expensive than Urgent Care visits.  In addition, insurance companies are considering rejecting claims for non-emergency visits to the ER. So be sure you are familiar with the ER policy and coverage in your healthcare plan before you experience an emergency and need to make a quick decision.

Urgent Care

Urgent Care is ideal for when your doctor’s office isn’t open, and for treating your family’s minor accidents and illnesses.  The average wait time in Urgent Care is 30 minutes or less.  Visit Urgent Care for:

  • Minor fractures, sprains, and dislocations
  • Cuts or bad scrapes needing stitches or expert bandaging
  • Minor burns
  • Flu symptoms including nausea, high fever, body aches, sore throat, and more
  • Stomach pain, nausea, vomiting, diarrhea, constipation
  • Headaches and migraines
  • Skin rash
  • Muscle strain or pain in the back or joints

Urgent care clinics often require a copayment and/or coinsurance that’s usually higher than an office visit or Telehealth visit, but less than an ER visit.

Emergency Room (ER)

Choose the ER if you think you or a family member has a life-threatening condition.  While some people may be tempted to utilize ER services because it’s open 24/7, the wait time may be several hours. Patients with life-threatening emergencies or critical conditions will be treated first so if you’re experiencing a minor ailment, it may not be the best place to seek care. Visit the ER for:

  • Heart attack symptoms: chest pain, difficulty breathing, shooting pains down an arm or leg
  • Stroke symptoms: slurred speech, weakness or numbness on one side, loss of vision or difficulty balancing
  • Head trauma, concussion, seizures
  • Severe cuts and abrasions with uncontrolled bleeding
  • Broken bones and dislocated joints
  • Serious allergic reactions
  • Fainting
  • Serious burns

Emergency room visits often require a much higher copayment and/or coinsurance than an office visit, urgent care visit, or Telehelath.

When Should You Call 9-1-1 for Help?

If you think there’s a severe life-threatening situation requiring immediate medical attention, it’s time to call 9-1-1. Call 9-1-1 for:

  • If a broken bone is breaking the skin or you’re in a great deal of pain
  • I a cut is very deep, and you can’t control the bleeding
  • If you’re unsure about the severity of the accident or medical event, especially in cases of a potential heart attack, stroke, or poisoning

Telehealth or Virtual Visit

If you are faced with a non-emergency health condition – like a migraine, sore throat, or stomachache – but your doctor’s office is closed, you may consider a virtual visit by phone or video. This allows you to virtually chat face-to-face with a doctor, anytime of the day or night, and may help you save money compared to a visit to the ER.  Virtual visits  are especially important for medical advice related to the on-going COVID-19 situation.  

Virtual visits are typically less expensive than either an Urgent Care or ER visit and are available 24/7.

Potential Costs

ERs are better equipped to manage major health issues, so they typically cost more to use.  And if it’s an emergency, there’s also the cost of the ambulance. Urgent care is less expensive than the ER, and a Virtual Visit has the lowest cost of the three options.

Insurance companies are considering rejecting claims for non-emergency visits to the ER.  This potential change might only affect commercial plans, or group plans, and may not affect Medicare or Medicaid plans.  However, these policies are evolving, so be sure you know what limitations, if any, you might have with your health plan coverage.

Medicare Supplement plans and Medicare Advantage Plans handle these costs differently.  In general, a supplement such as Plan G will cover the costs of ER visits and Urgent Care visits, as well as ambulance services, after you’ve paid the Part B deductible ($203 per year in 2021).  Medicare Advantage plans vary, but with most you will have a co-pay for ER visits, Urgent Care visits, ambulance services, and Teleheath or Virtual Vistis.

Make an Informed Choice

Remember, the severity of the illness or accident is the best way to tell whether you need to go to Urgent Care or the ER.  Minor conditions are best treated at Urgent Care or via Telehealth, and life-threatening ones require an ER.

Interested in Learning More About Your Medicare Benefits?

Reach out to us at 1-937-401-0260 or info@heartlandinsure.com to make your Medicare journey stress free.

Suzanne Werts
 is the Principal Broker with Heartland Insurance Group, specializing in Medicare Planning and Enrollment.

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