Sixty-four percent of uninsured people say they do not have medical insurance because it costs too much. Even after recent healthcare reforms, 27.5 million non-elderly people in the US remain without health insurance as of 2021.
Considering this data, Newport Urgent Care seeks to inform people about the affordability and easy access of urgent care and related services. There are a wide variety of options that are easier to pay for than an emergency room visit.
Whether you are insured or not, in this article, the costs of non-life-threatening healthcare options and alternatives will be explored.
What Is Urgent Care?
Let’s begin with an understanding of what urgent care is. Urgent care is different from an emergency room. The ER was designed to be like battlefield triage—a place ready to take care of, for example, gunshot victims, burn victims, people actively having heart attacks, or pedestrians hit by cars. However, since it now can often take a month to get an appointment with one’s primary care physician, people with less critical ailments started walking into ERs to get their broken arms x-rayed and their fevers diagnosed.
Urgent care was born out of the need to reduce emergency room traffic and offer a more affordable option for things that are not life-threatening emergencies (but, nonetheless, urgent). Urgent care offers same-day treatment only. There are no overnight hospital beds. Many urgent care facilities are only open during regular business hours.
Average Urgent Care Costs
If you get a deep cut on your finger and require five stitches, your average urgent care price tag for that is $150, according to an analysis by Forbes magazine. Some urgent care centers do offer discounted prices for people without insurance and/or those paying cash.
Additionally, some urgent care facilities may offer payment plans, credit/loan programs, sliding scales, or be willing to negotiate. In small towns where a single doctor may have her or his own practice, their prices for routine things can sometimes be cheaper than a regional urgent care center. Remember, the law requires that urgent care centers owned by hospitals can not turn you away because of an inability to pay—they must treat you.
Cigna has determined that the price of an average ER visit in the US is $2,259.
Debt.org reports that a typical emergency room visit in Maryland is $623, while the same ER visit in Florida would cost $3,102. Here is an overview of what you can expect to pay, on average, for various urgent care services:
- AIDS/HIV test: $60
- Blood test: $91.67
- Burn (minor): $122
- Diabetes blood sugar test: $32
- Electrocardiogram (EKG): $108.67
- Flu shot: $35.29
- IV (bag of intravenous fluid): $79.80
- Measles vaccination (MMR): $112
- Mononucleosis (mono) test: $41.75
- Physical exam for sports: $51
- Pink eye treatment: $142
- Pregnancy (blood) test: $43.13
- Sinus infection treatment: $142
- Sprained ankle: $174.50
- Stitches (5 or less): $149.50
- Strep throat: $75
- Stye treatment: $142
- Tetanus shot (Tdap): $81.29
- UTI (urinary tract infection): $142
- X-ray: $88.75-$132.80
- Wellness exam: $138.20
Other research shows the average cost of an urgent care visit for uninsured people based on which chain you might visit:
- American Family Care: $70-$140 (add-ons +$30-$315)
- CityMD: $200 (add-ons +$100-$600)
- Concentra: $181-446 (add-ons +$39-$446)
- Fast Med: $119-$199 (add-ons +$35-$113)
- MedExpress: $119-$239 (add-ons +$100)
Your location can greatly affect the price of just about everything – medical care included. Even if you’re in the most expensive city in the US, all of these prices are a lot more attractive than $2,259, the average ER visit cost. Here is a look at average urgent care visit price tags based on the city:
- Chicago: $166
- Houston: $180
- Las Vegas: $135
- Los Angeles: $175
- Manhattan: $189
- Milwaukee: $165
- Philadelphia: $178
- Salt Lake City: $175
- Seattle: $198
Factors Impacting Urgent Care Costs
Urgent care is like any other business—the overhead costs will impact their final prices. Some of the factors that urgent care centers are juggling include:
- The center’s physical location
- How much the center pays their staff
- What specific treatments does the center offer (which is generally based on how qualified their staff is and what equipment they have on-site)
Physical Location
Most retail businesses do not own their buildings or premises. They must pay rent. If they are located in a commercial center or shopping complex, they are also going to have to pay for something called a “triple net.” The triple net is like HOA dues in a condo building or a gated housing community. Things like big parking lots, convenient corner locations, and landscaping are all factored into the bottom line.
The urgent care centers with the lowest overhead costs are typically the ones embedded in a hospital, grocery store, pharmacy, senior care facility, etc. Free-standing, independent clinics will have the highest overhead and, therefore, usually the highest prices.
Staff Pay
Urgent care centers with a more expansive staff (doctors instead of just nurses, for example) generally cost more. You get what you pay for, as the saying goes. At some urgent care facilities, there are not any actual physicians on staff. Facilities with certified medical assistants supporting on-staff physicians instead of nurses providing that support will have a higher overhead.
Treatments Offered
Some urgent care facilities will have fancier equipment like EKG, ultrasound, or MRI scanning machines; others will not. Most urgent care centers will have just X-ray machines. An EKG machine can cost $50,000 or more. That is a high cost that will be imposed on clients. If you think about it another way, though, an urgent care EKG might be the most expensive service they offer, but it’s still cheaper than the same EKG in an emergency room.
Types of Urgent Care Costs
It’s wise to be aware of the different costs you may encounter while visiting an urgent care center. If you’ve heard of the No Surprises Act, you should know that this law does not apply to urgent care. The No Surprises Act is in place so people are aware of any and all charges they will face in advance ($25 band-aids during hospital stays, for example).
Here are a few urgent care-related financial terms to know for those with insurance:
- Deductible: This is the amount an insured person must pay out-of-pocket before their insurance company will start footing the bill. Deductibles apply to any kind of medical appointment covered by insurance (seeing a specialist, getting a check-up, visiting urgent care, etc). So, for example, you may be required to pay $500 (i.e., your deductible) out of pocket for medical costs at the beginning of each year until your insurance “kicks in” and then begins paying a portion for you. If you are familiar with how a car insurance deductible works, it’s the same concept. Some health insurance plans have deductibles as high as $1,500 per person per year.
- Co-Pay: A co-pay is like your “per visit” deductible. So, for example, if the doctor’s visit costs $100, your co-pay might be $40, and your insurance company pays the remaining $60. Urgent care co-pays are generally less than emergency room co-pays.
- Balance Billing: If an insured person goes to a doctor or medical center not covered by their insurance plan, their insurance company will enact “balance billing” to even out the cost. In other words, balance billing occurs when the insured person receives a bill charging them for the difference between what was covered for the unauthorized visit vs. what they paid on-site.
Financial Options for Uninsured Patients
Having health insurance is usually the best option. According to CommonwealthFund.org, two-thirds of uninsured people haven’t even tried to get health insurance. They haven’t done the research, made the phone calls, read the websites, or filled out any applications. Of the third of uninsured people who have looked into their insurance options, the majority said they could not afford the coverage available. Forty-two percent of those surveyed in 2018 reported that it was challenging to find health insurance they could afford. This is no surprise considering that the majority of uninsured people earned less than $25,000/year.
If this is your situation and you live in California, you no doubt qualify for completely free health insurance through Medi-Cal. Unmarried individuals qualify for no-cost Medi-Cal coverage if their income is less than $1,676/month (or $20,000/year). Single parents with one dependent and/or married couples earning under $2,267/month (or $27,000/year) also don’t need to pay a penny for anything with Medi-Cal. No co-pays, no deductibles, free prescription medication, no cost to see a specialist, plus no cost of dental care, eye exams, and counseling.
If you make a little more than these amounts, you can still get Medi-Cal coverage, but you may pay a very reduced fee for medication and doctor’s visits (potentially as low as $5-$10).
How Coalition OC Can Help
If you are located in Orange County like we are, and you do not have health insurance, please contact the non-profit organization Coalition OC. One of the many things they do is help uninsured people file for the right health insurance coverage, and their services are completely free (sometimes they can even submit your application for you—all you have to do is give them your details). They also speak Spanish.
If you live outside of Orange County but still in California, Coalition OC most likely can still help you. If they can’t show you which program to apply for and walk you through the application, they most likely can offer you a referral to a sister organization where someone else closer to home can assist you. You can reach Coalition OC at 714-352-5990 or contactus@coalitionoc.org.
Affordable Alternatives to Urgent Care for Non-Emergencies
Have you ever heard of the CVS Minute Clinic? Many people got their Covid-19 vaccination shots at CVS Minute Clinics. The CVS Minute Clinic is a type of “walk-in” clinic, which is the next level of access, simplicity, and affordability below urgent care. Walk-in clinics are generally embedded in pharmacies (so less overhead costs) and offer even more basic services than urgent care centers. Research has found that the CVS Minute Clinic costs 40% less on average compared to an urgent care center and 85% less than an emergency room.
As of June 2021, these are out-of-pocket prices for popular items at a CVS Minute Clinic:
- 30-Minute Established Patient Consultation: $69
- 45-Minute Established Patient Consultation: $99
- 75-Minute Established Patient Consultation: $149
- 30-Minute New Patient Consultation: $99
- 45-Minute New Patient Consultation: $139
- 75-Minute New Patient Consultation: $159
Walk-In Clinics v. Urgent Care
Should you go to a walk-in clinic or urgent care? To keep costs down, virtually all walk-in clinics do not actually have physicians on staff. Walk-in clinics have PAs (physician assistants) and/or nurses. PAs have 2-3 years of medical education compared to a doctor’s 6-9 years of medical training. Again, many urgent care facilities do have at least one doctor working at all times. As stated above, walk-in clinics offer only the most basic medical services (sports physicals, TB tests, vaccination shots). Walk-in clinics are not going to have things like X-ray machines.
Some similarities between walk-in clinics and urgent care centers are that they both have walk-in availability. You can also make appointments for both walk-in and urgent care clinics generally. Most walk-in clinics and urgent care centers tend to offer uninsured or cash discounts. Finally, both types of medical clinics accept insurance.
Getting Treated in Mexico
In southern California, where Newport Urgent Care is located, going to Mexico for medical care is very common. In the urgent care sphere of medicine, Mexico’s system is far more accessible and affordable than in the US. In Mexico, walk-in clinics are the standard, and their walk-in clinics are staffed by actual physicians.
For example, there are only 1,123 CVS Minute Clinics in the US, but in Mexico City alone, there are 15,000 walk-in clinics. Some of these walk-in clinics are located by all the US/Mexico border crossings and are generally staffed by English speakers. The walk-in clinics in Mexico charge $2-$6 US dollars for a basic consultation with a doctor (strep throat, rash, fever, etc). According to the LA Times, the most robust of these walk-in clinics, Farmacia Similares, provided 136 million physician consultations in 2022.
For those without dental, chiropractic, or eye care coverage through their current health insurance plans, Mexico is also a popular alternative. Here is a list from DentalMexico.com of prices to expect for common dental treatments in Mexico:
- Ceramic Crown: $170-$400 US dollars
- Temporary Crown: $10-$50 US dollars
- Titanium Dental Implant: $1,150-$1,596 US dollars
- Implant Crown: $250-$400 US dollars
- Flexible Partial Dentures: $400-$480 US dollars
- Temporary Partial or Flipper: $50-$145 US dollars
- Full Dentures: $230-$300 US dollars
- Metal Braces: $400-$500 US dollars
- Filling (Amalgam): $25-$35 US dollars
- Root Canal: $100-$300 US dollars
- 3-Unit Bridge: $420-$1,248 US dollars
- Extraction: $30-$250 US dollars
- Wisdom Teeth Removal: $50-$230 US dollars
- Night Guard: $30-$200 US dollars
You might also be surprised to learn that some dentists in Mexico accept US insurance plans. Those plans tend to include the following:
- Aetna Dental
- Blue Cross
- Blue Shield
- Cigna Dental
- Delta Dental Dental
- Denta Max
- Metlife Dental
- United Concordia
For Veterans
The Veterans Administration does offer urgent care coverage for qualifying US veterans.
Concierge Medical Plans
Another unique alternative for medical care is called “concierge” care. It’s like having your own private urgent care center. Because concierge medical centers are private, there is typically little to no wait. For example, according to Forbes, the average doctor has 4,000 patients under his or her care, whereas the average concierge doctor has just 600. Memberships to concierge facilities range from $100-$800/month.
Financial Assistance and Discounts for Uninsured Individuals
Two other options for uninsured people are unsecured medical loans and medical membership plans. Mira is an example of one of these medical membership plans. Unlike traditional insurance, Mira doesn’t cover expensive things like hospitalizations, but they do offer serious discounts on routine care. Check out some of Mira’s prices:
- Bloodwork: $1 (over $300 traditionally)
- STD testing: $99 (over $500 traditionally)
- Mental health therapy: $25 (as much as $250 per session traditionally)
- Prescription medication: 80% off
Mira also offers hospitalization negotiations. Much like a credit counselor can negotiate down your bills and get payments consolidated, Mira can help you negotiate, sometimes by as much as 50%, any hospitalizations you may occur. A one-year membership to Mira costs $25/month.
If none of these other options work for you, you can try getting an unsecured medical loan from a company like Care Credit.
You Can Trust Newport Urgent Care
Newport Urgent Care is passionate about serving the community, offering affordable alternatives, and empowering our patients through education and information. To learn more about what we offer, call us at 949-752-6300 or fill out our online contact form. You can also schedule an appointment with us online via zocdoc.com or solvhealth.com.
