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

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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's best for Average wait to be seen Typical cost (compared to other options)
Virtual care (video visits and phone visits) 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) Appointment follow-ups, treatment advice and questions about non-urgent care Within a few days Average or lower
Primary care clinic Routine check-ups or physicals, or diagnosing new symptoms Often within a week or two, but varies Average
Specialty clinics and surgery centers 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 Unexpected but mild or moderate health problems, like burns, cuts, scrapes, sprains, and cold and flu symptoms Same day Average to higher (coverage varies)
Emergency room, or ER 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 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
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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.
 Here’s what we recommend

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. Virtual care, e-visits and in-person visits can all be good options, depending on your needs.
  • For non-emergency care when 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. Virtual care may help you 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 care.
  • 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.
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:

 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.
Comparisons Urgent care Emergency room (ER)
Best for Injuries or symptoms that are serious enough to be seen right away but aren’t life-threatening Life-threatening emergencies or severe medical issues
When open Days and early evenings 24/7
Common situations Mild to moderate burns, scrapes and cuts; coughs; fevers; sore throats; cold, flu and strep symptoms; sprains, strains and dislocations; gastrointestinal issues 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 threats or suicidal thoughts
Cost Usually less than the ER Usually more than urgent care
Wait to be seen Usually faster than the ER, because ERs prioritize people who need critical care first Depends, with people who need more critical care prioritized first
If you need more specialized care Your urgent care doctor can immediately refer you to an ER, and they often won’t charge you for your urgent care visit Most ERs are attached to full-service hospitals
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).

 Contact our 24/7 CareLine℠ (HealthPartners members)
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 a virtual visit. 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.

 Sitting in a health care clinic’s waiting room, several people quietly scroll through their phones. How to check 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.
When should I use virtual visits?

Virtual visits are an excellent option if you need to talk with a health care professional about something that’s bothering you. Even better, some plans cover virtual visit providers more favorably than other providers – sometimes even at no cost to you.

 Sitting on a couch at home, a man greets his doctor via video chat on his laptop. What your health plan covers

Virtual visits (telemedicine) are 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 virtual visits are covered under your plan, which providers are in your plan’s network and how much a visit costs.