Medicare Coverage for Coronavirus Testing and Treatment (COVID-19)
Medicare is taking aggressive actions to ensure coverage for beneficiaries who find themselves facing the Coronavirus or COVID-19. There’s no doubt that we’re living through an unprecedented pandemic. From testing to treatment, Medicare is working fast to bring relief to Americans.
Many Medicare beneficiaries are wondering if they have coverage for costs associated with Coronavirus testing & treatment. Medicare is monitoring the Coronavirus and making necessary steps for offering complete coverage. Below, we’ll review current policies in place for Medicare coverage and costs regarding COVID-19.
This page was updated 4/3/20
Medicare Coverage for Coronavirus Testing
CMS announced that Medicare would cover Coronavirus testing for those tested after February 4th, 2020. Testing for COVID-19 will be covered under Medicare Part B. Medicare Advantage enrollees will also have coverage for COVID-19 testing since Advantage plans are required to cover all services that both Part A and Part B cover. Additionally, there is no cost-sharing under Medicare for services related to the COVID-19 test.
Under normal circumstances, beneficiaries would be responsible for cost-sharing for the associated doctors’ visit. However, all cost-sharing associated with the COVID-19 test itself has been eliminated by the House of Representatives. SEC. 6001 of H.R. 6201 states all health insurance shall not impose any cost-sharing, including deductibles, copays, and coinsurance, that’s associated with the COVID-19 test.
Any service received during this emergency period that resulted in administering the COVID-19 test will be covered 100% by Medicare. This applies to both Original Medicare and Medicare Advantage benefits.
COVID-19 Testing Sites
Testing sites are beginning to pop up throughout the U.S. Drive-through sites are a great alternative to doctors’ offices. Beneficiaries will not have to pay anything out of pocket when using one of these pop-up testing sites. All beneficiaries who are at least 65 years old will be considered a priority.
Medicare Coverage for Treatment for COVID-19
As of now, aside from treating the symptoms, there is no known treatment for COVID-19. Now, cost-sharing has been eliminated for services that resulted in administering the COVID-19 test, but those cost-sharing costs have not been eliminated for any services related to treating COVID-19.
For any COVID-19 treatment administered in an inpatient setting, that would fall under Part A. Beneficiaries admitted into the hospital for COVID-19 treatment will be responsible for the Part A deductible, as well as any copays for extended stays. Beneficiaries enrolled in a Medigap plan will have coverage for the Part A deductible, which is $1,408. It will also cover copays for extended hospital stays up to an additional 365 days.
For any COVID-19 treatment administered in an outpatient setting, that will fall under Part B. Beneficiaries are responsible for both the Part B deductible and the 20% coinsurance. Beneficiaries with a Medigap plan will also have coverage for the 20% coinsurance that falls under Part B. Depending on what letter plan the beneficiary enrolled in; they could also have coverage for the Part B deductible.
Those with a Medicare Advantage plan, your cost-sharing will depend on the carrier you enrolled with. The carriers determine what you will pay in copays and coinsurance. The carrier has the authority to waive or reduce your cost-sharing, but are not required to do so.
Medicare Coverage for a COVID-19 Vaccine
If a vaccine were approved for the Coronavirus, the current law would cover it either under Part B or Part D. The vaccine could be subject to deductible and cost-sharing requirements. Under Part B, preventive vaccines are not subject to the coinsurance and deductible. If the vaccine is not considered “preventive,” cost-sharing will apply. Under Part D, cost-sharing for vaccines will vary.
We will update this page accordingly as we learn more regarding a future COVID-19 vaccine.
Section 1135 Waiver
The COVID-19 public health emergency has given CMS the versatility to issue waivers such as Section 1135. These blanket waivers provide flexibility in coverage so that beneficiaries can access health care during this pandemic.
Out of Network Coverage Restrictions Waived
Stand-alone prescription drug plans and Medicare Advantage plans are private plans. These private plans limit your ability to receive coverage for services obtained from out of network providers.
Fortunately, during the current declared national emergency, Medicare Advantage plans must cover services related to the Coronavirus outside of their network of providers. They must also charge the same amount for those services as they would’ve if the provider were in-network.
Part D plans are required to make sure all enrollees have adequate access to their medications from pharmacies, both in-network as well as out-of-network. Part D plans also have flexibility regarding other methods of delivering medications such as mail and home-delivery.
Telehealth Services Restrictions Waived
According to Administrator Seema Verma: “As we continue to learn about the COVID-19 virus, it’s important for all Americans, and particularly vulnerable populations who are at heightened risk, to be able to access their providers when they feel sick or have questions.”
“Over the last three years, President Trump’s leadership and historic efforts have made it possible for doctors to bill for their time on the phone or video chat with patients to help triage medical issues. Today, a patient who is not feeling well can call their doctor to decide whether or not they need to go in for a visit, offering solutions and peace of mind immediately.”
Waiver 1135 waives restrictions on telehealth services that are covered under Medicare, such as virtual check-ins and e-visits, allowing widespread use of telehealth services in a variety of settings.
Effective for services starting on March 6th, 2020, a beneficiary in any geographic area has the option to use telehealth services. This is NOT restricted to COVID-19 related services; it’s available to all beneficiaries. Telehealth visits include preventive health screenings, mental health counseling, and regular office visits.
For those who believe they have Coronavirus symptoms, you can check-in with your physician. You’ll be able to talk with your doctor about your symptoms and any questions you have. At that point, your physician will decide whether you need to come in for a test or help you locate a local drive-through for testing. During this COVID-19 public health emergency, providers have been given the flexibility to either waive or reduce cost-sharing for telehealth visits.
Steps You Can Help Take
You can take steps to help the rising number of Coronavirus cases. You can make sure to have any over-the-counter medications and supplies you might need. Household items and groceries are essential when staying at home.
Remember to wash your hands thoroughly and keep up with household cleaning. Try to avoid excess traveling and congregating in large groups. By staying home as much as you can, you may be able to help reduce the spread of the virus.
Understanding what your insurance covers is essential. Especially in times like now, while the world faces a health crisis. Please call our team of Medicare experts if you have any questions about your current policy. We’re all in this together! You can also find podcast recordings & transcripts from CMS regarding COVID-19 on their open door forum.