Emergency room vs urgent care - Medicare

Emergency room vs urgent care


Planning ahead can help you make the right decisions when the unexpected happens.

Emergency room has physician & facilty fees, treatement costs and higher copays. Urgent care has facility fee, treatment cost and regular copay. Telehealth has treatment costs and lower copay.Americans make more than 130 million visits to the emergency room every year. According to the Centers for Disease Control and Prevention, the most common reasons for ER visits include stomach and abdominal pain, chest pain, fever, headache and back pain.

While some of these symptoms, like chest pain, can indicate a serious condition, many can be treated at an urgent care center. Another option is telehealth—which means having a doctor appointment over the phone or video chat.

Making a trip to the emergency room can cost up to five times more than a visit to an urgent care center or telehealth, so it pays to know where to go.

When to go to the ER

If you're experiencing any of the following, go to the ER:

  • Signs of a heart attack, such as chest pains that last more than two minutes
  • Signs of stroke, such as numbness of the face, arm and leg on one side of the body, sudden loss of vision or loss of speech
  • Severe shortness of breath or sudden dizziness
  • Bleeding that doesn't stop after 10 minutes of direct pressure
  • Major injuries such as broken bones, partial or total amputation of a limb, or trauma to the head
  • Coughing up or vomiting blood
  • Suicidal feelings

To find an in-network hospital near you, use Find a Doctor.

When to go to urgent care

If you are experiencing the following symptoms, go to an urgent care center:

  • Cuts or wounds where bleeding is controlled
  • Sprains, strains or bruises
  • Mild or moderate asthma attacks
  • Infections of the urinary tract, ear or upper respiratory system
  • Flu-like symptoms, such as sore throat, fever, coughing and congestion
  • Mild or moderate stomach pains or diarrhea
  • Rashes, insect bites or sunburns

Not only do you save money by going to urgent care, you will probably have a shorter wait time, too.

Locate an in-network urgent care center by using Find a Doctor. Using an out-of-network urgent care center will cost you more.

When to use telehealth

If you're experiencing the following, you can use telehealth—which means having a virtual doctor visit—through MDLIVE®. These conditions can be treated through telehealth:

  • Flu-like symptoms, such as sore throat, fever, coughing and congestion
  • Joint aches and skin infections
  • Infections of the urinary tract, ear or upper respiratory system
  • Pink eye
  • Rashes, insect bites or sunburns
  • Mild or moderate asthma attacks

While these conditions can also be treated at an urgent care center, telehealth is often more convenient and cost-effective. The great thing about telehealth is that it lets you get care anytime, anywhere—whether it's after normal business hours, you're traveling outside your network area or you just can't get to the doctor's office. The doctor can even send your prescription to the nearest pharmacy.

Telehealth is also a good option for therapy appointments for conditions like depression, anxiety, grief and loss, and bipolar disorders.

Find out more about your telehealth benefit through MDLIVE.

Still not sure what to do?

If you can't decide where to go or how to get treatment, call your primary care provider. Even if it's after hours, there may be a nurse or on-call doctor you can talk to.

Your health plan may also provide you with access to the Advice24 nurse line where you can get guidance on where to go.

If you don't have a primary care provider, start with urgent care or telehealth. You can usually get in to an urgent care center relatively quickly, and most are open in the evenings and on weekends. Telehealth is usually available 24/7, 365 days a year.

Many people end up in the ER because they don't know what else to do. By having a plan and thinking ahead, you can make smart choices that are good not only for your health, but your budget as well.

Last updated 08/27/2020
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