If
you’re ever in need of health care, you have many options that are defined by
your needs. Sometimes, it can be difficult to know which type of care provider
you should go to. Many people consider the emergency room a catch-all location
to visit for things that need attention, but many visits are potentially
unnecessary, costing the health care system around $8.3 billion annually.
There
are two other locations that are worth understanding that can help relieve the
burden on emergency departments. These are urgent care centers and retail
health clinics. Understanding the differences between the three, and when to go
to each, can save money and be more convenient for the beneficiary and the
health care system.
Emergency Department
So,
first, let’s discuss emergency departments, also known as emergency
rooms. Emergency
departments are part of larger hospitals designed to handle
patients that need care immediately. They cover a wide range of problems that
are often critical, hence the emergency aspect of the department. The focus
usually is on stabilizing the patient so that treatment can be given either in
an inpatient or outpatient setting. For example, an emergency department may
stop you from dying of a heart attack, but they won’t treat the heart disease that led to it.
When You Need It
First
of all, if you’re concerned that you need an emergency room, it’s better to be
safe than sorry. So, if you’re showing signs of a heart attack, stroke, or
potentially life-threatening situation, call 9-1-1 and go to the emergency
room. This can include symptoms like chest pain, profuse bleeding, or fainting, among others. To boil it down to a good rule
of thumb: if you need immediate or life-saving care, go to the emergency room.
Does Medicare Cover
It?
Emergency department visits are generally
covered by Medicare, but there are some costs. You’ll owe a Part B copay for
each visit, as well as a copay for each hospital service you use. On top of
that, you’ll pay 20 percent of the Medicare-approved amount and any costs you
may receive as part of inpatient care. You should be wary of observation
status in these cases.
Urgent Care
Urgent
care centers are outpatient care for acute or
chronic illnesses and injuries. These locations are set up for beneficiaries
that need to see health care professionals right away. To handle this, most
urgent care centers have long hours or are open 24 hours. This can also
alleviate congestion issues at emergency rooms, where almost half of patients
who are turned away, tend to go to the ER because their doctor’s office was closed.
Since urgent care centers are walk-ins, they often don’t know your medical
history, so it can be important to bring medical documentation and a photo ID
to verify who you are. There’s also a chance you may not be treated by a
doctor, but by a licensed physician assistant or nurse practitioner.
When You Need It
Urgent
care centers may sound like emergency departments, but the difference is that
they’re not set up to handle lifesaving care. Using this as a guideline, we can
begin to figure out the broad scope of urgent care center services. Broken
bones, allergic reactions, infections, and wounds are all examples of reasons
to go
to an urgent care clinic. Our rule of thumb to go by with urgent
care centers: if you need care now, but it’s not life-threatening, go to urgent
care.
Does Medicare Cover
It?
Generally
speaking, Medicare does cover urgent care clinic services through Part B. These
are treated like emergency room services, meaning you’ll receive the same
coverage as you would for those after you reach the Part B deductible.
Retail Health Clinics
Retail
clinics are one of the fastest growing types of health centers in
the United States, and it makes sense when you learn what they are. These
clinics are connected with retail outlets like CVS, Rite Aid, Walgreens, Target, or other similar stores. They are
often staffed by nurse practitioners and other qualified staff. Gearing toward
convenience, retail health clinics allow you to
research prices in advance, often have short wait times, and are located in
many retail chain and grocery stores.
When You Need It
Unlike
the other two entries in this article, retail
health clinics deal more with illnesses and preventative care
and less with immediate and emergency care. They can help with low level
injuries like sprains, burns, and cuts. They can also help you if you have the
flu, a cold, or need diagnosis for an illness. Retail health clinics do more
than just hand out medications and band aids, though. You can have physical
examinations, health screenings, and even get vaccinations there! Our rule of
thumb: if you’re sick or a little hurt, want to prevent yourself from getting
sick, go to a retail health clinic. If you need help now, go to the others.
Does Medicare Cover
It?
Many
retail health clinics accept Medicare coverage, which allows you to be covered
under Part B’s outpatient coverage. Some may choose to opt-out
of accepting Medicare. It’s worth researching and ensuring the
clinic accepts Medicare coverage before receiving care.
● ● ●
None of
these outpatient care centers could or should ever replace the services
provided by your primary care physician, but when unique circumstances hit you,
these three care centers are uniquely placed to fulfill your needs. Knowing the
difference between the three can make a monumental difference. Not only can it
save you money, by not going to the emergency room over something an urgent
care or retail health clinic could solve, it can save you time and free up
space for people in need of life-saving care.
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