Coronavirus-related Testing and Vaccination are fully covered by Medicare and normally you would not incur any out-of-pocket costs for these services. Treatment is covered in the usual way like any other illness requiring inpatient care. Read on for more details.
Is COVID-19 Testing covered by Medicare?
Medicare has announced that it will cover Coronavirus testing under Part B as a 'clinical diagnostic laboratory test' if it is ordered by your healthcare provider as medically necessary. Clinical diagnostic laboratory tests have no cost-sharing so you should not have to pay any out-of-pocket costs. No Part B deductible. No coinsurance.
Testing-related services are covered as well e.g. if you have to visit a physician's office or hospital for the test. It is recommended that you do this after speaking to your healthcare provider, over the phone if needed, so that they can do the initial screening and you go in only when a test is going to be administered. Otherwise Medicare may not cover the visit. Emergencies are another matter altogether.
I have a Medicare Advantage (Part C) Plan. Am I covered for Testing?
Short answer is Yes. You are covered for COVID-19 testing. The Families First Coronavirus Response Act also includes Medicare Advantage (Part C) Plans. You do not have to pay any out-of-pocket costs for COVID-19 testing, including testing-related services. It also bars the use of prior authorizations so you do not need your Plan to authorize your COVID-19 testing. Note that you still need your healthcare provider to order the test.
Are vaccines covered as well, including booster shots?
According to Medicare.gov, 'you pay nothing for the Covid-19 vaccine'. No deductible, No copay, No administrative fee to get the shot.
This applies to booster shots as well. Medicare covers booster shots at no cost to you, whether it is the same vaccine as your initial Covid-19 shot or a different Covid-19 vaccine.
What about Treatment? Does Medicare cover Coronavirus-related treatments?
In-Network vs Out-of-Network
COVID-19 has been declared a public health emergency but this will not continue indefinitely. You may want to contact your Medicare Advantage plan and ask them about cost-sharing for Covid-19 related hospitalizations.
Part D Plan Sponsors may be required to ensure that enrollees have adequate access to covered Rx at out-of-network pharmacies if they cannot be 'reasonably' expected to use in-network pharmacies. To help meet social distancing and lockdown needs, it is recommended to have a supply of your medications for an extended duration (up to 90 days). Due to COVID-19, Part D Plan enrollees may now be able to request up to 90-day supply of their prescription medicines. This includes MA Plans which cover Part D prescription drugs. Check with your Part D Plan.
Are Skilled Nursing Facilities covered?
SNF stays have always been part of Medicare, provided pre-requisites like a three-day hospital stay were met, though the hospitalization requirement may have been temporarily lifted. Also note that Medicare does NOT cover long-term services like extended stays in a nursing home.
Coverage of recuperation in a SNF usually needs a prior, associated hospital stay under Medicare. This requirement has been waived temporarily for those patients who are impacted by the COVID-19 public health emergency. It also allows SNFs to restrict visitation rights and implement social distancing guidelines within the confines of the SNF.
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Last Updated: 01-10-2021