- As of February 4, 2020, Medicare covers novel coronavirus testing free of charge for all beneficiaries.
- Medicare Part A covers you for up to 60 days if you’re admitted to the hospital for the treatment of COVID-19, the illness caused by the 2019 coronavirus.
- Medicare Part B covers you if you require doctor’s office visits, telehealth services, and certain treatments for COVID-19, such as ventilators. It also covers vaccines.
- Medicare Part D covers COVID-19 outpatient medications that aren’t already covered by parts A or B.
- There may be some costs related to your care associated with COVID-19 and the novel coronavirus, depending on your plan and your deductible, copayment, and coinsurance amounts.
In March 2020, the
COVID-19 is the newest illness caused by different strains of coronaviruses.
Whether you’re enrolled in original Medicare (parts A and B) or Medicare Advantage (Part C), you can rest assured knowing that you’re covered for testing for the 2019 coronavirus as well as for diagnosis of and treatment for COVID-19.
In this article, we’ll explore everything you need to know about what Medicare covers for the 2019 coronavirus and the illness it causes.
Medicare has provided beneficiaries with information on how the agency is contributing during the COVID-19 pandemic. Here’s what Medicare will cover if you‘re a beneficiary:
- 2019 coronavirus testing. If you’ve been experiencing the symptoms of COVID-19, you should be tested. Medicare covers the necessary testing for the novel coronavirus completely free of charge.
- COVID-19 treatment. Many people who contract the novel coronavirus may have no symptoms. If you develop an illness from the virus, you may be able to ease your symptoms at home with over-the-counter (OTC) medications. Any prescription medications that you receive for COVID-19 will be covered by Medicare.
- COVID-19 hospitalizations. If you’re hospitalized because of illness due to the novel coronavirus, Medicare will cover your inpatient stay for up to 60 days.
Almost all Medicare beneficiaries fall into at-risk populations for serious COVID-19 illness: individuals 65 years old and over and those with chronic health conditions.
Because of this, Medicare is playing an important role in ensuring that these groups are being taken care of during this pandemic.
Medicare will continue to adjust its coverage as needed for beneficiaries who’ve been affected by the novel coronavirus.
2019 CORONAVIRUS: UNDERSTANDING THE TERMS
- The 2019 coronavirus, or novel coronavirus, is called SARS-CoV-2. This stands for severe acute respiratory syndrome coronavirus 2.
- SARS-CoV-2 causes an illness called COVID-19. This stands for coronavirus disease 2019.
- You may be tested to see whether you’ve contracted the virus, SARS-CoV-2.
- You may develop the disease, COVID-19, if you’ve contracted SARS-CoV-2.
- You can be asymptomatic, which means you have SARS-CoV-2 without having symptoms of COVID-19.
If you’re enrolled in Medicare, you’re covered for novel coronavirus testing with no out-of-pocket costs. This coverage applies to all novel coronavirus tests performed on or after February 4, 2020.
Medicare Part B is the part of Medicare that covers novel coronavirus testing. Here’s how the coverage works:
- If you’re enrolled in original Medicare, you’re already enrolled in Medicare Part B. You’ll be covered for the test.
- If you’re enrolled in Medicare Advantage, you’re already covered for all services under Medicare Part B.
- If you have a Medigap plan with your original Medicare, it won’t come into play. This is because all Medicare beneficiaries will be covered for novel coronavirus testing at no cost.
As a Medicare beneficiary, you’re covered for doctor’s visits if you have COVID-19.
In addition to covering laboratory testing, Medicare Part B also covers the diagnosis and prevention of medical conditions, which includes doctor’s visits.
Costs for these visits can vary depending on the type of plan you have. Here’s how that coverage works:
- If you’re enrolled in original Medicare, you’re already enrolled in Medicare Part B and are covered for doctor’s visits.
- If you’re enrolled in Medicare Advantage, you’re covered for Medicare Part B and any necessary doctor’s visits.
- If you have a Medigap plan with your original Medicare, it may help cover your Medicare Part B deductible and coinsurance costs.
Keep in mind that people who are experiencing only mild COVID-19 symptoms are advised to stay at home. However, if you still want to speak with a doctor, you can take advantage of your Medicare telehealth options.
Does Medicare cover telecare for COVID-19?
Telemedicine is used by health professionals to offer medical care to individuals via interactive telecommunication systems.
As of March 6, 2020, Medicare helps cover telehealth coronavirus services for Medicare beneficiaries who meet the following criteria:
- You’re enrolled in Medicare Part B through original Medicare or Medicare Advantage.
- You’re seeking treatment and other medical advice for COVID-19.
- You’re at home or in a doctor’s office, an assisted living facility, a hospital, or a nursing home.
If you choose to use Medicare’s telehealth services for COVID-19 diagnosis and treatment, you’ll still be responsible for your Part B deductible and coinsurance costs.
If you have Medigap, some plans may help cover these costs.
Medicare beneficiaries who may be affected by COVID-19 can choose to seek either in-person or telehealth services for testing, diagnosis, and treatment.
If you’re experiencing more serious symptoms of COVID-19, you may need treatment at a hospital. In this case, telehealth services may not be enough.
If you think you may have COVID-19 and need to go to an emergency room, call ahead if possible to let them know that you may have COVID-19 and are on your way.
If you’re experiencing mild symptoms of COVID-19, Medicare’s telehealth services might be a better option for you.
They’ll allow you to receive medical advice from the comfort of your home and without increasing your risk of transmitting the virus to others.
Contact your doctor or healthcare provider for more information about the telehealth services they may offer.
All Medicare beneficiaries are required to have some sort of prescription drug coverage. As a beneficiary, you should already be covered for existing COVID-19 drug treatments as well as any other COVID-19 drug treatments that may be developed.
The Food and Drug Administration (FDA) has approved remdesevir (Veklury), an intravenous (IV) infusion therapy, for people with COVID-19.
It has also granted emergency use authorizations (EUAs) to other medications, including these IV infusion therapies:
- casirivimab and imdevimab, which must be administered together
EUAs may be granted in circumstances where there are no FDA-approved products available to help diagnose, treat, or prevent a condition.
Remdesevir is used to treat severe illness and is administered to people who’ve been hospitalized.
Bamlanivimab and casirivimab-imdevimab are given to people who have mild to moderate disease and are at high risk of disease progression.
These outpatient therapies must be given in a setting where a healthcare provider can administer and monitor the infusions. Examples include:
- emergency rooms
- outpatient hospital facilities
- infusion centers
The purpose of these therapies is to help prevent hospitalization.
Here’s how the Medicare drug coverage works:
- If you’re enrolled in original Medicare, you must be enrolled in Medicare Part D as well for prescription drug coverage. Medicare Part D plans will cover outpatient prescription drugs necessary in the treatment of COVID-19.
- If you’re enrolled in Medicare Advantage, your plan likely covers prescription drugs and vaccines for COVID-19. Contact your plan provider to learn exactly what’s covered.
- If you have a Medigap plan that was purchased after January 1, 2006, your plan doesn’t cover prescription drugs. You need to have a Medicare Part D plan to ensure you have help paying for your prescription drugs, since you can’t have both Medicare Advantage and Medigap.
Medicare Part D typically covers most prescription drugs for people on Medicare.
In the case of COVID-19, many of the the treatments that are currently FDA-approved or FDA-authorized will be covered by Part A (because they’re given to people who are hospitalized) or Part B (because they’re physician-administered or infusion drugs) instead.
For mild cases of the novel coronavirus, experts recommend that you remain at home and rest. Some milder symptoms, such as fever, can also be treated with OTC medications.
More serious confirmed cases of the novel coronavirus may require hospitalization for treatment of the symptoms, especially if they include:
If you’re been admitted to the hospital for the novel coronavirus, Medicare Part A will cover hospitalization costs. Here’s how the coverage works:
- If you’re enrolled in original Medicare, Medicare Part A covers you 100 percent for inpatient hospital stays of up to 60 days. This includes any medications, such as remdesevir, that you may receive. You’ll still need to pay your Part A deductible before Medicare pays out, though.
- If you’re enrolled in Medicare Advantage, you’re already covered for all services under Medicare Part A.
- If you have a Medigap plan with your original Medicare, it’ll help pay for the Part A coinsurance and hospital costs for an additional 365 days after Medicare Part A stops paying. Some Medigap plans also pay a portion — or all — of the Part A deductible.
A ventilator may be necessary for people with COVID-19 who are hospitalized and can’t breathe on their own.
This treatment, which the Centers for Medicare & Medicaid Services (CMS) defines as durable medical equipment (DME), is covered under Medicare Part B.
In general, either Medicare Part B or Medicare Part D can cover vaccines when they’re necessary to prevent illness.
Here’s how the coverage works:
- If you’re enrolled in original Medicare, Medicare Part B will cover the cost of your vaccine.
- If you’re enrolled in Medicare Advantage, your vaccine is also covered under Medicare Part B.
- If you’re only enrolled in Medicare Part D, your vaccine won’t be covered by your Medicare plan. However, during the pandemic, the vaccine will be free for almost all people in the United States, regardless of their insurance status.
- If you have a Medigap plan, that means you’re already enrolled in original Medicare. Medicare Part B will cover the cost of your vaccine.
Medicare consists of Part A, Part B, Part C (also known as Medicare Advantage), Part D, and Medigap.
No matter what kind of Medicare coverage you have, new Medicare policy has made sure that you’re as covered as much as possible for COVID-19 care.
Medicare Part A
Medicare Part A, or hospital insurance, covers:
- hospital-related services
- home health and nursing facility care
- hospice services
If you’re admitted to the hospital for COVID-19, you’re covered by Part A. Any medications you receive while in the hospital are also covered by Part A.
Medicare Part B
Medicare Part B, or medical insurance, covers the prevention, diagnosis, and treatment of health conditions.
If you require diagnostic doctor’s visits, telehealth services, or COVID-19 testing, you’re covered by Part B.
Any medications administered by your doctor are covered by Part B. COVID-19 vaccines are also covered by Part B.
Medicare Part C (Medicare Advantage)
Medicare Part C, also called Medicare Advantage, covers both Medicare Part A and Part B services. Most Medicare Advantage plans also cover:
- prescription drugs
- dental services
- vision service
- hearing services
- other healthcare perks, such as wellness programs
Any novel coronavirus services that are covered under Part A and Part B are also covered under Medicare Advantage.
Medicare Part D
Medicare Part D, or prescription drug coverage, helps cover your prescription drugs. This plan is an add-on to original Medicare.
Any outpatient drug treatments that aren’t already covered by parts A or B will be covered by Part D.
Medigap, or supplemental insurance, helps cover the costs associated with Medicare Part A and Part B. This plan is an add-on to original Medicare.
If you have costs associated with your COVID-19 care, those may be covered by Medigap.
Medicare offers a wide variety of COVID-19 coverage for Medicare beneficiaries. Under Medicare, you’re covered for the testing, diagnosis, and treatment of COVID-19.
While the novel coronavirus test is completely free for all Medicare beneficiaries, there may still be some out-of-pocket costs associated with your diagnostic and treatment services.
To find out your exact coverage and costs for COVID-19 care, contact your Medicare plan administrator for specific information.
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