Choosing where to go for care: Cost, coverage and more

In a park on a sunny day, three adults practice tai chi

When you’re sick or injured, you want to feel better as soon as possible. Fortunately, with health insurance, you have options for getting the care you need.

But not all care options are the same. Some providers might be able to see you sooner, but others might offer care that costs less. Knowing where to get the care that best fits your situation can save you both time and money.

Comparing your health care options

So where should you go when you need health care? This chart can help point you in the right direction:

Care setting What it is Best for Average wait to be seen Typical cost (compared to other options)
Telemedicine (online care, video visits and phone visits) Health care wherever you are (through a computer or mobile device) Routine visits or mild health problems that don’t require an in-person exam Often same day, but varies Average or lower (coverage varies)
E-visit Online messages with your doctor and their care team Appointment follow-ups, treatment advice and questions about non-urgent care Within a few days Average or lower
Primary care clinic (doctor’s office) Appointments with a doctor or clinician for common needs Routine check-ups or physicals, or diagnosing new symptoms Often within a week or two, but varies Average
Specialty clinics and surgery centers Appointments with a doctor or clinician for specialized needs Chronic or non-urgent conditions that need care and treatment from a specialist or surgeon Often within a month or two, but varies Average
Urgent care clinic (including orthopedic urgent care) Health care in a clinic dedicated to urgent medical needs Unexpected but mild or moderate health problems, like burns, cuts, scrapes, sprains, and cold and flu symptoms Same day Higher (coverage varies)
Emergency room (ER) Health care in a special section of a hospital dedicated to medical emergencies Unexpected but major health problems, like serious injuries, chest pain, shortness of breath, severe stomach pain, severe bleeding and severe allergic reactions Same day Highest
Hospital Health care in an advanced medical facility for chronic, serious or complex medical issues Short- and long-term medical conditions that require monitoring, and pre- and post-operation care Same day (in an emergency) or varies (if you’re visiting for treatment) Highest

Know before you go with our cost estimator tools

Many HealthPartners plan members can get detailed information about how much care visits might cost with our cost estimator tools. We’ll give you an idea of how much you might expect to pay for your care at different providers and locations, taking into account your specific plan’s benefits and network.

Where will I pay the least for my health care?

How much you’ll pay for your health care mainly depends on three factors:

  1. Health condition – Care for minor health conditions like cuts and colds, as well as preventive care and routine care (like check-ups), tends to cost less – sometimes even nothing at all. Care to manage a major health condition or life-threatening emergency tends to cost more.
  2. Care location – Getting care over the phone or through your computer or mobile device may cost less than going to a physical location. How your care location is meant to be used also matters. For example, if you have a minor or everyday health issue, getting care at an emergency room or urgent care clinic will probably cost you more than going to a primary care clinic. That’s because at an ER or urgent care clinic, you’re paying for more complex care and services than your minor issue really needs.
  3. Time – How quickly you need care also matters. Care that can wait for a scheduled appointment typically costs less than urgent care clinics and emergency rooms, which are designed for situations where you need help immediately and can’t wait.

Every situation is different, but here’s what we generally recommend to get the right care in the right way at the right price:

  • For preventive care, routine care and non-emergency care when you don’t need to be seen right away, make an appointment with your regular in-network primary care doctor. Telemedicine, e-visits and in-person visits can all be good options, depending on your needs.
  • For non-emergency care where you’d like to be seen soon, try to make an appointment with your regular in-network primary care doctor. If you can’t, try an e-visit with your care team, or see if you can go to a different doctor at your regular clinic or different location within your regular care system. Telemedicine may enable you to be seen sooner if your concern doesn’t require an in-person exam.
  • For non-emergency care that needs attention as soon as possible, go to an in-network urgent care clinic. Some urgent care clinics offer virtual visits.
  • For emergencies, go to your nearest emergency room or dial 911. Your health comes first, and emergency care is always covered as if it were in network. There are also protections in place to help make sure you don’t get a surprise bill.

If you’re able to, always use cost estimator tools to get a better sense of what you’ll pay for the service you want at the location you want to go to.
In their living room, a mother holds a thermometer while looking at her young son resting on a couch with a pillow, blanket and teddy bear

When should I go to urgent care? When should I go to the emergency room?

If you can’t wait to see a primary care doctor and need help immediately, it’s best to go to either an urgent care clinic or an emergency room (ER). But knowing which one is right for your situation isn’t always clear.

Here are some things to consider:

Urgent care

When you have injuries or symptoms that are serious enough to be seen right away but aren’t life-threatening, an urgent care clinic is best. This often includes:
  • Mild to moderate burns, scrapes and cuts
  • Coughs; fevers; sore throats; and other cold, flu and strep symptoms
  • Sprains, strains and dislocations
  • Gastrointestinal issues

Urgent care visits typically cost much less than a trip to the ER. And since urgent care clinics specialize only in mild to moderate health issues, you’ll likely be seen sooner than you would in an ER. This is because ERs prioritize people who need critical care first, so people with less serious concerns can wait a long time.

But if you show up to an urgent care clinic with something that seems minor yet turns out to be serious, don’t worry. Your urgent care doctor can immediately refer you to an ER, and they often won’t charge you for your urgent care visit.

Emergency room

If you have a life-threatening emergency or severe medical issue, call 911 or go to your local emergency room immediately.

Emergency rooms treat critical health issues like:

  • Major injuries
  • Severe burns, bleeding or vomiting
  • Chest pain or trouble breathing
  • Severe stomach or head pain
  • Severe allergic reactions or poisonings
  • Mental health crises, such as suicidal thought or threats

Since ERs are open 24/7, they’re also good for after-hours injuries or symptoms that you’d otherwise take to urgent care but can’t wait until morning.

Not sure if you need urgent care or the ER? A nurse line care help.

If you’re still unsure where to go, many health insurers and care systems have phone numbers for their members and patients to talk to a nurse directly. You can describe your symptoms over the phone and get advice on whether it’s serious enough for the ER or can be handled at urgent care (or even wait to be seen at a primary care clinic).

Many of these nurse lines are available 24/7, such as our CareLine℠.
Sitting in a health care clinic’s waiting room, several people quietly scroll through their phones

How can I get a doctor’s appointment faster? How do I see a specialist quickly?

Seeing a doctor at a pre-scheduled appointment time is often a less costly option for your care. But getting same-day or same-week appointments can sometimes be difficult.

However, with a little flexibility, seeing a doctor within a few days is usually possible. Try one of the following:

  • See if your doctor or care team can see you through a virtual visit – If you don’t need to be seen in person, doctors may be able to speak with you sooner through telemedicine. Virtual visits often don’t take as much time as in-person visits, so doctors tend to have more flexibility to add a virtual visit than an in-person one.
  • See another doctor at your clinic – Health care clinics are typically home to several providers. If a doctor can’t fit you in, another one may have space or a cancellation and be able to see you right away. Plus, if you’re already seeing a doctor at the same clinic, it’s likely they’ll be able to quickly share your medical records so you get more personal care.
  • Go to another clinic in your care system – If your care system has other clinics near you, it’s possible another doctor in another location has time available. Again, if you’re already seeing another doctor within the same care system, your medical records can often be shared so your care is more tailored.

Whichever option you choose, it’s always a good idea to check that whomever you plan on seeing is in your health insurance plan’s network. This can save you the likely higher expense of seeing someone who’s not in your plan’s network.

For care that can wait a week or more, it’s worth it to plan ahead. Get into the habit of making appointments well in advance, especially for preventive care and maintenance care for chronic health conditions. Most clinics can make appointments months and even years ahead of time. Making your appointments further into the future can help you get the best pick of days and times to see your preferred doctors or specialists.
Sitting on a couch at home, a man greets his doctor via video chat on his laptop

When should I use telemedicine (virtual visits)?

Telemedicine is another excellent option if you need to talk with a health care professional about something that’s bothering you. Even better, some plans cover telemedicine providers more favorably than other providers – sometimes even at no cost to you.

Telemedicine is especially good for:
  • General health advice
  • Counseling and talk therapy
  • Common allergies
  • Cold and flu symptoms
  • Sinus infections
  • Bug bites
  • Minor first- and second-degree burns
  • Cuts, scrapes and sores
  • Skin rashes, conditions and infections
  • Acne
  • General women’s health
  • Sexual health and more

Check with your health insurer to see if telemedicine is covered under your plan, which providers are in your plan’s network and how much a visit costs. HealthPartners plan members can use Virtuwell for in-network treatment for dozens of conditions.