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COVID-19 Testing and Treatment

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.

COVID-19 Testing and Treatment

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 phobne so that they can do 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.

Medicare Part B also covers an FDA-approved antibody (serology) test for Covid-19 to determine if a person has developed an immune response to Coronavirus, where the person has been diagnosed with or is suspected to have been infected by Coronavirus.

I have a Medicare Advantage (Part C) Plan. Am I covered?

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. 

What about Treatment? Does Medicare cover Coronavirus-related treatments?

Medicare Part B covers an FDA-approved Covid-19 monoclonal antibody treatment if you are diagnosed with Covid-19 and are at risk of progressing from a mild case to a severe one.
 
The usual Medicare cost-sharing rules apply to COVID-19 related inpatient and outpatient services. Depends on which and what type of Plan you have. Part A and Part B deductibles, copays and coinsurance will apply if you have 'Original Medicare'.
 
If you have a Medicare Advantage Plan, your costs depend on how your Plan is structured and charges for inpatient care. Many MA Plans have announced that they are temporarily waiving or reducing hospitalization costs for Covid-19 and are also waiving pre-authorization requirements. However, but this is not a requirement and depends on your MA Plan.

If you have to be quarantined after treatment for public health reasons and would otherwise have been discharged, you will not have to pay a separate deductible for the quarantine in a hospital.

If you have a Medicare Supplement Plan it may help bear some of the cost burden but remember that Supplement Plans do not have any limits on cost-sharing, except for Plan Types K and L (Massachusetts, Minnesota and Wisconsin are different). If you have Medicaid, the very nature of the program implies that it will result in much lesser out-of-pocket costs.

In-Network vs Out-of-Network

COVID-19 has been declared a public health emergency. During this emergency, Medicare Advantage Plans are required to cover applicable out-of-network services and charge for them as if the services had been provided in-network.

Part D Plan Sponsors are 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. 

Are Skilled Nursing Facilities covered?

SNF stays have always been part of Medicare. 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 is being waived 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.

What about Covid-19 vaccines? Are they covered?

Medicare covers all FDA-approved Covid-19 vaccines.
 
There is no out-of-pocket cost for the vaccine if you have Medicare Part B or are enrolled in a Medicare Advantage (Part C) Plan.
 
If you only have Part A of Medicare, you may still not pay any out-of-pocket cost though some vaccine providers may charge an administrative fee.
 
I heard I can now get 90-day supplies of my medications

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 are now able to request up to 90-day supply of their prescription medicines. This includes MA Plans which cover Part D prescription drugs. 

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Last Updated: 01-10-2021