Medicare & Coronavirus – What Is and Isn’t Covered
With COVID-19 striking seniors and those with pre-existing health conditions with brutal force, it’s no surprise that many Medicare recipients are left in the dark wondering what type of coverage they’ll have if they get sick and need hospitalization.
The good news is many of the costs associated with coronavirus will be covered by Medicare, although Medicare recipients may still be looking at a large bill if hospitalization is needed.
Is COVID-19 Testing Covered by Medicare?
On March 3, the government announced that Medicare Part B will cover the COVID-19 test to see if you have coronavirus when ordered by your physician or other medical provider. You generally pay nothing for lab tests covered by Medicare. Anyone with Part B coverage tested on or after February 4 will be covered.
What Other COVID-19 Expenses Will Medicare Cover?
Most Medicare beneficiaries have only basic Medicare which does not cap out-of-pocket costs and includes Part B (outpatient coverage) and Part A (hospital coverage).
With Medicare Part A, hospitalization that’s medically necessary is covered. If your health is such that your doctor recommends quarantine in a hospital instead of at home, for example, or you are admitted for treatment, you will pay a $1,408 deductible for Part A assuming you do not have additional coverage.
The part A deductible covers the first 60 days of hospitalization per benefit period. After that, there is a daily copay of $352 that is charged for up to the 90th day. After that, the daily rate is $704.
If you are moved to a skilled nursing facility, you won’t have a copay for your first 20 days but it will be $176 daily after that.
If a vaccine is developed for COVID-19, Medicare recipients with Part D coverage will be covered. Those without a Part D or a Medicare Advantage plan with prescription coverage will need to pay for any vaccine developed out of pocket.
Telemedicine has become an increasingly safe and popular way to see a doctor during the coronavirus pandemic. If you use an online patient portal, video, or phone to check in with your doctor, Medicare will cover the cost.
Medicare Part B covers outpatient care including doctor’s visits, whether they are done in an office or through telemedicine. Part B has a $198 deductible and most beneficiaries pay 20% of the covered cost.
Many of these out-of-pocket costs of Medicare and coronavirus can be covered if you have a Medigap policy, a private, supplemental form of health insurance. Only about 25% of people with traditional Medicare have Medigap coverage.
What if You Have a Medicare Advantage Plan?
Nearly 24 million people on Medicare get Part A and Part B coverage through a Medicare Advantage Plan. These plans often include prescription coverage as well with or without a monthly premium that’s paid in addition to what you pay for basic Medicare.
If you’re covered by a Medicare Advantage Plan, you have the same benefits for medically necessary hospitalization and lab tests. These plans can waive the cost-sharing for lab tests related to coronavirus. Many Medicare Advantage Plans are offering extra telemedicine benefits as well.
According to an analysis by the Kaiser Family Foundation, Medicare patients with an Advantage Plan tend to pay more than patients with just basic Medicare coverage on long hospital stays.
Note: regulators have informed Advantage Plans operating in states with emergency declarations that they must cover services in participating out-of-state facilities and charge the same rate as in-network facilities.
It’s important to check the rules of your particular plan as they can vary significantly. Many Medicare Advantage Plans have made changes like waiving some preauthorization requirements and expanding telehealth services during the coronavirus. Two of the largest insurance companies in the U.S., Humana and Cigna, have also said they will waive patient costs for coronavirus treatment.
Expanded Telehealth Services Under Medicare
Due to the widespread COVID-19 pandemic, CMS has expanded its telehealth policy for Medicare patients. Previously, CMS has not allowed beneficiaries to use telemedicine to communicate with a doctor but the risks associated with social contact have encouraged them to loosen their regulations.
You can communicate with your doctor via Skype, FaceTime, or other types of technology as long as you have both video and audio capabilities and still have your visit covered by Medicare. Just note that this temporary change does not cover therapy services.
While there isn’t much information about the average treatment cost for coronavirus in the United States or the typical length of stay in a hospital, one study found that the average stay in Wuhan, the epicenter of the outbreak, was 10 days for patients who recovered. Another study on the length of stay in a U.S. hospital for pneumonia found an average 3-day hospital stay. Patients who needed a ventilator for more than 96 hours spent 22 days on average in the hospital.