Coronavirus and Medicare – What You Need to Know
Medicare-age adults and individuals with pre-existing health conditions are at a greater risk of being seriously affected by the coronavirus. According to the Centers for Medicare and Medicaid Services (CMS), 25% of 1.2 million Medicare beneficiaries infected by COVID-19 as of September 12, 2020, were hospitalized.
Coronavirus testing, treatment, and vaccination are all covered by Medicare. But you’ll need to know which parts cover which services and what you’ll be expected to pay.
Coronavirus testing under Medicare
Medicare Part B covers testing for COVID-19. Initially, a doctor’s order was required for the test to be covered. However, CMS quickly eliminated that requirement so beneficiaries would have easier access to COVID-19 testing. For example, you can go to a drive-through testing facility without first having to see your doctor.
Coronavirus testing under Medicare Part B is not subject to any cost-sharing expenses, meaning you will not owe your Part B deductible or coinsurance if you get tested. Medicare may cover more than one test as well. Before, Medicare beneficiaries were able to get multiple COVID-19 tests without a physician’s orders. However, according to CMS and its interim final rule released on August 25, 2020, subsequent testing may require an order from your physician.
Medicare Advantage plans are required to cover Part A and Part B services at least as well as Original Medicare covers them. Therefore, all Medicare Advantage plans are also required to cover COVID-19 testing without any cost-sharing. Medicare and Medicare Advantage plans also cover COVID-19 serology tests, or antibody tests, that may be able to detect if you’ve been infected by COVID-19 in the past.
Coronavirus treatment under Medicare
Coronavirus treatment varies from patient to patient as there are many levels of severity of the disease. Depending on the severity of your illness, your doctor may recommend quarantining at home if you have a mild case or admitting you to a hospital if you have a more severe case or pre-existing medical conditions.
Medicare Part A covers inpatient care in facilities such as hospitals and skilled nursing facilities. Medicare Part B covers outpatient care and other doctor services such as doctor exams, certain medications, lab work, x-rays, and durable medical equipment.
Part B services used to treat COVID-19 are subject to the annual Part B deductible, which is $203 in 2021. Once you have met your deductible, Part B will cover 80% of the Medicare-approved rate for Medicare-approved Part B services. You’ll be responsible for a 20% coinsurance.
If you’re admitted as an inpatient, the Part A deductible will cover the first 60 days of your hospital stay and the first 20 days of your skilled nursing facility stay. The Part A deductible in 2021 is $1,484. If you have an extended stay, you will owe a daily copay for each day past the 60- and 20-day marks.
If you have a Medicare Advantage or Medigap plan, your out-of-pocket costs will vary. For example, a Medicare Advantage plan may have no hospital deductible but a $295 daily copay for your first five days as an inpatient. If you have a Medigap plan, your plan will simply cover a specific set of Part A and Part B cost-sharing expenses. For example, if you have Medigap Plan G, you will only be responsible for the Part B deductible.
Coronavirus vaccination under Medicare
Medicare covers a variety of vaccines. You’ll find that Medicare Part B covers most preventive vaccines such as the flu vaccine, pneumonia vaccine, and hepatitis B vaccine. As coronavirus vaccines are being developed and authorized for emergency use, Medicare is covering them. Preventive vaccines, including the coronavirus vaccine, is covered at 100% without any Part B cost-sharing.
Medicare-age people and those with pre-existing conditions are among the highest priority groups for receiving the COVID-19 vaccine. As each county receives its shipment for this group of individuals, more Medicare beneficiaries will be able to start the vaccination process.
Improved telehealth coverage under Medicare
Medicare has improved its telehealth coverage since the start of the coronavirus pandemic. Before, Medicare generally only covered telehealth services for specific individuals. However, now Medicare covers telehealth services for all beneficiaries. If you have a telehealth doctor visit, Part B will cover your visit like a regular doctor visit. Therefore, the deductible and coinsurance will apply. However, some doctors are currently waiving cost-sharing for telehealth services during the pandemic.
The coronavirus can be scary, but fortunately, now you know that Medicare will cover your care throughout the process, from getting tested and treated to having follow-up telehealth appointments with your doctor.