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What’s Changing in Medicare Post COVID


COVID was a game-changer for people across the globe, especially for insurance companies and Medicare. Many wonder how cost-sharing for testing, treatments, and a vaccine will look. Also, people are curious if COVID will be a pre-existing condition. It’s clear that COVID impacted the world; in fact, Medicare has expanded telehealth and mental health services due to the coronavirus. Let’s look at COVID and Medicare’s details.

What Will COVID Cost-Sharing Look Like With Medicare?

First, let’s take a look at Medicare coverage for testing Coronavirus. For testing, Part B covers you when you go to a laboratory, pharmacy, doctor, or hospital. The testing should take place in your local area. You won’t pay anything for the COVID test when you have Medicare. In some cases, Medicare covers a home health nurse, lab tech, or other medical assistants to collect your specimen in your home for the test. Further, 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 will cover inpatient hospital stays, home health visits, skilled nursing facilities, and hospice. But, Part A costs will apply to these services. Now, patients that require hospital quarantine when they would otherwise be discharged won’t need to pay an additional deductible.

Then, Part B will cover outpatient services such as doctor visits, ambulance transportation, and emergency room visits. But, beneficiaries that don’t have a Medigap plan will be responsible for deductibles and coinsurances. Part B will also cover a COVID-19 monoclonal antibody treatment if you test positive for COVID, have mild to moderate symptoms, and you’re at high risk for a severe case of COVID.

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, will Medigap consider COVID a pre-existing condition? Again, it’s possible. That’s why it’s important to sign up for Medigap during the 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 health care 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 good as Medicare. So, Part C plans can’t 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; this isn’t a requirement, though. Also, plans may waive prior authorizations for services relating to COVID.

How Will the Pandemic Affect Medigap Rate Increases?

Some carriers are going to apply a smaller 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 company with similar information, you can call the carrier to ask any questions.

Will Medicare Cover At-Home COVID Tests?

Yes, Medicare will cover three at-home COVID tests. The costs can range from $25 – $50. These tests include:

  • Ellume COVID test
  • Abbott’s BinaxNOW COVID-19 Ag Card Home Test
  • Lucira COVID-19 All in One Test Kit

The accuracy of these tests is above 90%. Also, the FDA has given these three tests “emergency use authorization.” So, even though they haven’t gone through rigorous approval, they needed to be on the market swiftly due to the pandemic.

Are Medicare Beneficiaries Comfortable Taking a COVID Vaccine?

Yes, more than half feel comfortable receiving the vaccine.

FAQs

Will the COVID 19 vaccine be covered by Medicare?
Yes, Medicare Part B will cover the COVID 19 vaccine. There will be no cost-sharing, meaning you won’t have to pay anything out of pocket to receive the vaccine once it’s available. The two vaccines recommended by the CDC include the Pfizer-BioNTech and Moderna’s vaccine.
Who should get a COVID-19 test?
Those with symptoms, those who have been in close contact with a person with COVID, and those who have a doctor’s recommendation for testing need to get a COVID test. Not everyone will need testing. While waiting for results, it’s suggested that you quarantine.
How do I get a COVID-19 test with Medicare?
You can see your doctor or other approved testing site; Medicare will cover you at an approved facility. CVS even has a drive up testing option.
Will Medicare cover a COVID-19 antibody test?
Medicare will cover testing for COVID-19 antibodies at no cost to beneficiaries.
Does Medicare pay for COVID 19 testing?
Part B will cover preventive vaccines in full, so you pay no costs. Now, since Medicare would require a vaccine to have coverage with no cost-sharing, those with Part C won’t be subject to payment.

How to Find a Medicare Plan During the Pandemic

Usually, beneficiaries choose to receive help with their Medicare coverage from a broker, in person. However, due to the pandemic, most Medicare enrollees are now going online for help. That's where we can help! Our Medicare resource center is filled with educational material to make the process as easy as possible for you.

If you're looking for a Medicare plan during this pandemic, our team of agents can help you identify a policy that meets your needs and brings you value.  Let us help you, call us at the number above to see your options. Or, fill out an online rate form to get your rates now.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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