COVID is a game-changer for people across the globe. Predictably, it requires many adjustments from insurance companies and Medicare. The availability of telehealth and mental health services through Medicare has increased due to the coronavirus.
Additionally, there is speculation about whether prior infection with COVID-19 will be a pre-existing condition. It is essential to understand your cost-sharing responsibilities for testing, treatments, and vaccines. We are here with all the information you need about COVID and Medicare.
What Does Cost-Sharing for COVID Look Like on Medicare?
First, let’s take a look at Medicare coverage for coronavirus testing. Medicare Part B covers COVID-19 tests in laboratory, pharmacy, doctor’s office, or hospital settings, which should be local to you. You will not pay anything for the COVID test when you have Medicare.
In some cases, Medicare covers a home health nurse, lab tech, or other medical assistant to collect your specimen in your home for the test. In addition, Medicare covers tests at various locations, including parking lot testing sites.
Next, Medicare covers coronavirus treatment, but some cost responsibility will fall on the beneficiary. For example, Part A of Medicare will cover inpatient hospital stays, home health visits, skilled nursing facilities, and hospice. But, Medicare Part A costs will apply for these services. Further, patients who require hospital quarantine when they would otherwise be discharged will not need to pay an additional deductible.
Finally, Part B of Medicare will cover outpatient services such as doctor visits, ambulance transportation, and emergency room visits. But, beneficiaries without a Medigap plan will be responsible for deductibles and coinsurance. Medicare Part B will also cover a COVID-19 monoclonal antibody treatment if you test positive for COVID, have mild to moderate symptoms, and are high risk for a severe case.
Will Medicare Consider COVID a Pre-Existing Condition?
Insurance companies may consider COVID a pre-existing condition. But, Original Medicare is a public health program that covers people with pre-existing conditions.
The bigger question is: will Medigap carriers consider COVID a pre-existing condition? Again, it is possible. Thus, it is important to sign up for a Medicare Supplement policy during your Medicare Supplement Open Enrollment Period.
How is Medicare Changing Post-COVID?
COVID is increasing patient access to both telehealth and mental health services. In response to the public health emergency, there was a Medicare expansion on telehealth. The expansion took place to help patients and doctors maintain social distancing measures.
Medicare acknowledges the stress people are experiencing due to the pandemic. In a post-COVID America, increased access to mental health care will be a high priority. Prolonged isolation and living through a global pandemic increase the need for therapy. Plus, most mental healthcare services can now take place through telehealth.
What Will Coronavirus Cost-Sharing Look Like With a Medicare Advantage Plan?
Medicare Advantage plans must cover at least as much as Medicare. So, like Original Medicare, Medicare Part C plans cannot charge any copayments or coinsurances for tests to detect or diagnose COVID-19.
Cost-sharing for COVID-19 treatment will vary across Medicare Advantage plans. But, many Medicare Advantage insurers will waive coronavirus cost-sharing – however, this isn’t a requirement. Also, plans may waive prior authorizations for services relating to COVID.
How Will the Pandemic Affect Medigap Rate Increases?
Some carriers will apply a minor increase at the beginning of the year and then implement the full increase later during the year. The reason for doing this is to try to keep rate increases lower during the pandemic. If you receive a letter from your plan’s carrier with similar information, you can call them with any questions.
Does Medicare Cover At-Home COVID Tests?
According to the Biden-Harris administration’s January 15 mandate, private insurance companies must cover eight at-home COVID-19 tests. As of April 2022, if you have Original Medicare or Medicare Advantage, you will have full coverage for up to eight over-the-counter COVID-19 tests per month.
The tests must all be FDA-approved and available through certain pharmacies and other entities.
As one of the most susceptible groups to the virus, seniors can utilize these resources to receive free at-home tests.
COVID-19 Guidelines for Nursing Homes
Nursing homes have undergone several changes in the wake of the coronavirus. Some facilities are beginning to accept visitors, but protocols may vary. The number one priority is to slow the spread of COVID-19 and reduce the number of people exposed. That is why Medicare has required weekly reports of vaccination numbers for residents and staff to the Centers for Disease Control and Prevention.
In conjunction with the new rule, Medicare requires certain nursing homes and facilities to offer vaccinations and education about the shots to residents, staff, and clients.
Does Medicare Cover the COVID-19 Vaccine?
Medicare Part B covers the COVID-19 vaccine. There is no cost-sharing, meaning you do not have to pay anything out-of-pocket to receive the vaccine.
The CDC recommends the Pfizer-BioNTech and the Moderna COVID-19 vaccine.
At-Home COVID-19 Vaccinations for Medicare Beneficiaries
CMS aims to make it easier for high-risk individuals in group living settings, such as assisted living facilities and group homes, to get vaccinated. In an effort to increase vaccine availability, CMS now allows COVID-19 vaccinations at the homes of Medicare beneficiaries who are homebound or have severely limited mobility. The requirements for CMS to pay providers for this service include multiple residents receiving the vaccinations in a single home setting.
Does Medicare Pay for COVID-19 Booster Shots?
Medicare covers an additional dose of the COVID-19 vaccine. It is identical to the original vaccine but serves as another layer of defense against the virus.
Beneficiaries can mix-and-match the vaccines, meaning they can get their booster from the same or a different manufacturer than the original two. As COVID-19’s latest omicron variant looms large, many people seek extra protection from the virus.
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