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COVID-19 Testing and Treatment Coverage

The Families First Coronavirus Response Act includes multiple provisions to ensure that Medicare enrollees will not have to pay any out-of-pocket costs for Coronavirus Testing if it is ordered by your healthcare provider. Treatment is another matter though. Read on for more details. 

COVID-19 Testing and Treatment Coverage

How can I get tested for COVID-19?

Call your doctor, healthcare provider or your state or local health department first if you are developing symptoms and think you may be infected by Coronavirus. Follow their instructions. CDC now has a self-checker tool available on their website. You can also go to the ProjectBaseline.com website.

More testing kits are being manufactured and are becoming available by the day. Many communities have instituted drive-by-testing programs. Talk to your healthcare provider or health department and they will be able to advise you on the recommended course of action.

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.

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?

First of all, please understand that as of now there is no known 'treatment' for COVID-19. As a result, healthcare providers are currently treating symptoms by providing medical support. For example, if one has fever or difficulty breathing one may be treated to reduce the fever or to provide breathing support through ventilators or other equipment.

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, you may have a different set of deductibles, copays and coinsurance.

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.

On the other hand, Medicare Advantage Plans have out-of-pocket expenses capped. MA Plans may reduce or waive some of the treatment costs related to COVID-19 but they are not required to do so.

There may be more relief coming your way. There are already plans for a further stimulus bill and some MA Carriers have announced plans to mitigate COVID-19 treatment 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.

Is there a vaccine for Coronavirus? Will I have to pay for it?

There is currently no vaccine for COVID-19.

When a vaccine is developed, it is expected to be covered under Medicare with no out-of-pocket costs for beneficiaries, just like other preventive vaccines e.g. influenza. This applies to both 'Original Medicare' and Medicare Advantage Plans.

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: 11-17-2019