What are the Different Outpatient Health Care Options?

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 Insurance 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 Insurance Cover It?

Generally speaking, Medicare insurance 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 Insurance Cover It?

Many retail health clinics accept Medicare insurance 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 insurance coverage before receiving care.

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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.