A few years ago, our cat bit my husband while he was trying to give her a pill. The doctor’s office was closed for the weekend, so we waited nearly five hours at the emergency room to get a prescription for an antibiotic. And on top of everything else, we had a $100 insurance copay.
This trip to the ER was a big pain, but we figured we had no choice at the time. But we could have saved ourselves a lot of hassle by going to an urgent care center instead. These facilities can’t handle every health emergency, but for many conditions, they offer faster and cheaper care than a hospital ER.
Urgent Care vs. Emergency Room
Hospital emergency rooms are designed to deal with life-threatening conditions. They have the equipment and the staff to diagnose and deal with conditions like a heart attack or stroke. And if your problem needs more than a quick fix, they can admit you to the hospital.
Urgent care facilities are for problems that aren’t life-threatening but still need prompt medical care — like my husband’s cat bite. They have the equipment necessary for basic jobs like taking X-rays or giving a shot. They can typically get you in and out faster than a hospital ER.
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But for many people, the No. 1 determining factor in where they get emergency care is cost, especially if they don’t have insurance.
Average Cost of Care Without Insurance
By law, hospital ERs aren’t allowed to turn patients away, even if they can’t pay. As a result, many people who lack health insurance rely on the emergency department as their primary source of health care.
To make up for all these nonpaying patients, ERs charge higher rates to everyone else. That makes the emergency room one of the most expensive places to get care — with insurance or without it.
ER Cost of Care Without Insurance
An ER visit can easily cost upward of a thousand dollars, even for a relatively minor condition. Health insurer Medica provides a detailed look at what hospital ERs charge to treat specific conditions:
- Allergies: $1,021
- Bronchitis: $1,367
- Earache: $1,000
- Pink Eye: $621
- Strep Throat: $1,301
- Urinary Tract Infection: $1,592
These are the average amounts hospitals bill patients’ insurance for these conditions. If you don’t have insurance, your cost could be a bit lower since hospitals sometimes charge lower fees for self-pay patients. But you must cover that whole cost on your own.
Urgent Care Cost of Care Without Insurance
Patients without insurance typically pay under $300 for a basic urgent care visit unless they require extra procedures, such as X-rays. Medica also breaks down urgent care centers’ average costs for different conditions:
- Allergies: $253
- Bronchitis: $268
- Earache: $245
- Pinkeye: $200
- Strep Throat: $237
- Urinary Tract Infection: $259
Average Cost of Care With Insurance
The cost of care with insurance is harder to calculate than the cost without it. Insurance plans vary widely in how they pay for care and how much they cover. Thus, the cost of care with insurance depends on your plan. However, it’s generally lower at urgent care centers.
ER Cost of Care With Insurance
All health insurance plans cover the cost of emergency room care. However, they don’t usually cover the entire cost.
With many plans, a trip to the emergency room requires a copayment of between $50 and $300. Other plans charge coinsurance, which is a percentage of the bill, typically 10% to 30%. And some plans have both, such as a $150 copay plus 20% coinsurance.
For instance, suppose you go to the hospital emergency room with an earache, and it costs $1,000. Coinsurance would be $100 to $300. If you have a copay on top of coinsurance, the total cost could be anywhere from $150 to $600.
Additionally, most health plans have a deductible, the amount you must pay out of pocket each year before your insurance coverage kicks in. If you haven’t reached the deductible on your insurance for the year, you could be on the hook for the entire bill.
There’s one additional wrinkle. Because emergency room care is so expensive, health insurance companies often refuse to cover it for anything but a true emergency. If you go to the ER for a sprain or sore throat, you could end up paying the whole cost yourself.
Urgent Care Cost of Care With Insurance
Most insurance policies cover the cost of an urgent care visit. There’s usually a copayment, but it’s often less than the copayment for a higher-priced emergency room visit. It can be anywhere from $20 to $100, depending on how complex the visit is.
If your plan has coinsurance instead of a copayment, it will also be less because the overall bill is lower. If you went to urgent care with an earache, the total cost would typically be around $245. Coinsurance for this would range from $24.50 to $73.50.
As with ER visits, the deductible from your health insurance also applies. If you haven’t reached your deductible for the year, you may pay the full cost of an urgent care visit out of pocket.
However, going to urgent care still saves you a lot more money. Even the more expensive visits are cheaper than an ER visit for the same condition.
Cost isn’t the only factor to consider when choosing between the ER and an urgent care center. It’s also important to know what types of care each facility can and can’t provide and how long you should expect to wait for it.
ER Non-Cost Considerations
The most significant advantage of going to an emergency room is that the staff there can treat almost any medical emergency, no matter how serious. They have many doctors on staff with a wide variety of specialties, and they have sophisticated equipment for diagnosing and treating problems. And if necessary, they can check you into the hospital for long-term treatment.
Because of this, any problem that could be life-threatening requires a trip to the ER. Examples include chest pain, difficulty breathing, sudden weakness, loss of consciousness, head injuries, uncontrolled bleeding, severe abdominal pain, and possible poisoning.
Other factors to consider when visiting an ER include:
- Wait Time. It’s possible to get care quickly in an ER. However, ERs practice triage, meaning they always treat the patients in the greatest danger first. If your problem is not life-threatening, you’re more likely to wait over an hour to see a doctor or leave without receiving care at all.
- Length of Stay. Once you see a doctor or nurse, your time at the ER is just beginning. Expect to spend a couple of hours or more in the emergency room before being discharged if you have a relatively minor condition.
- Hours. Hospital ERs are open 24/7. No matter when an emergency arises, you can get treatment for it.
- Payment. By law, the ER has to provide enough care to stabilize you — to make sure you’re out of danger and your condition won’t get worse — whether or not you can pay.
Urgent Care Non-Cost Considerations
Urgent care centers can treat medical conditions that are urgent but not deadly. Examples include severe pain, infection, fever, minor illnesses like a sore throat or ear infection, and minor injuries (like minor cuts, minor burns, sprains, and broken bones).
Some other considerations when visiting urgent care include:
- Wait Time. There’s no triage at an urgent care center. Treatment is first come, first served, so it just depends on how busy they are, but it’s typically a shorter wait time than the ER.
- Length of Stay. In most circumstances, an urgent care visit takes only an hour or so from start to finish.
- Hours. Most urgent care centers are open every day. But they typically close between 8pm and 10pm on weekdays and around 4pm on weekends and holidays. However, some urgent care centers provide 24/7 treatment.
- Payment. Unlike ERs, urgent care centers don’t have to treat people who can’t afford to pay. They typically require payment on the spot, either upfront or through insurance.
The Verdict: Should You Choose the Emergency Room or Urgent Care?
For any problem that’s serious but not deadly, urgent care centers provide faster and cheaper care than hospital ERs. So the choice between the two depends on what’s wrong with you and what’s available nearby.
You Should Go to the Emergency Room If…
Despite its cost, the emergency room may be the better choice for some patients. The ER is a better fit if:
- Your Problem Could Be Life-Threatening. If you have a problem that could kill you without immediate treatment, you need to go to the nearest ER. There, you’ll go straight to the front of the line to get the care you need to stabilize you.
- There’s No Urgent Care Center Nearby. Not every community has an urgent care center nearby. You can search for one near you on Solv. If you don’t find any, head for the emergency room.
- It’s After Hours. Even if you find an urgent care center nearby, it may not be open if it’s a weekend or late at night. But hospital ERs are always open. That said, if your problem can safely wait until morning, you’ll pay less by waiting until the urgent care center opens.
- You Can’t Afford to Pay. If you have no money or insurance, the hospital emergency room must treat you anyway. But the urgent care center is within its rights to turn you away.
You Should Go to Urgent Care If…
For most patients with conditions that are pressing but not life-threatening, urgent care is a better fit. Choose urgent care if:
- Your Problem Isn’t Deadly. Urgent care centers can handle various nonemergency medical problems cheaper than an ER.
- The Center Is Open. Most urgent care centers aren’t open 24/7. If your problem arises outside the facility’s business hours, you have to decide whether it can safely wait until the center reopens in the morning.
- You Can Pay for It. You can’t get care at an urgent care center if you have no money. You have to provide payment at the time of your visit, either with insurance or out of your pocket. Fortunately, the bill should be less than you’d pay at an emergency room.
When you’re deciding where to go for medical care, there are two questions you should ask yourself. The first is, “Can it wait?” If the answer is yes, make an appointment to see your primary care doctor. That’s cheaper than a trip to an urgent care center, especially with insurance.
The second question is, “Is it life-threatening?” If it is or could be, then bypass the urgent care center and head straight for the emergency room.
If the answer to both questions is no, that’s when an urgent care center is your best choice. You’ll get in and out faster than at the ER, and you’ll probably pay less too, with or without insurance. It’s one of the best strategies for coping with rising health care costs.