Emergency Room vs. Urgent Care – What to Know When You're on Medicare

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When you're sick or injured, the last thing you want to do is wait for care ― or pay more for treatment than you need to. That's why it's important to understand your care options. If you need to see a doctor outside of regular office hours, the emergency room isn't your only option. You have choices ― and the right one can save you time and money.

Your doctor

If you have a primary care physician (PCP), they'll be your first line of defense. Your PCP knows you and your medical history, so they play an important role in helping you get healthy and stay healthy. Call them to discuss any ongoing health concerns or routine, nonemergency issues. Your PCP can treat things like coughs and colds, the flu, headaches, an upset stomach, minor infections, rashes and skin irritation, and sinus and respiratory infections.

Some doctors' offices have a doctor or nurse on call, even when their office is closed. If you get sick after hours, try calling your PCP. They may offer this service.

Remember, your PCP must accept Medicare. If you have a Medicare Advantage plan, you'll also want to make sure your doctor is in the plan's network. This will help keep costs down.

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Urgent care

You can't predict when you're going to get sick or hurt. That's why urgent care can be a great choice for nonemergency issues ― especially if you can't get an appointment that day with your PCP. Most urgent care centers have flexible hours and may be open nights and weekends. They can provide the same level of care as your doctor and you may pay a lot less for treatment than you would at the ER. Go to urgent care for things like blood work, minor burns, minor head injuries, simple fractures and sprains, cold symptoms, and X-rays.

Most urgent care centers accept Medicare, but not all. Be sure to check before you go.

Emergency room

When serious or life-threatening issues arise, the ER should always be your first choice for care. If you need immediate medical attention, call 911. Go to the ER if you experience chest pain, acute changes in vision, coughing blood, loss of consciousness, an overdose, a seizure, a stroke, a severe allergic reaction, a serious burn, or trauma.

If your issue isn't an emergency, you'll want to call your PCP or head to your local urgent care center. Otherwise, you may end up waiting a long time to see a doctor. You also might pay more for treatment than you would at an urgent care center or your PCP's office.

Knowing your care options can help you take control of your health, so you can make the right health care choices for you and your wallet.

Chrissy Costa is a health care writer at Aetna with experience in senior wellness, Medicare, commercial health care, and consumer engagement. When Chrissy isn't at the gym, she enjoys spending time with her husband and daughter, trying out new restaurants, and watching too much TV. Chrissy lives in Marlborough, Massachusetts and has a degree in journalism from Emerson College.

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