COVID is a game-changer for people across the globe. Predictably, it’s requiring many adjustments from insurance companies and Medicare. The availability of telehealth and mental health services through Medicare continues to increase due to the coronavirus.
Additionally, there is speculation about whether past infection with COVID-19 will be a pre-existing condition. It’s important to understand your cost-sharing responsibilities for testing, treatments, and vaccines. We’re 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. Part B covers COVID-19 tests in laboratory, pharmacy, doctor’s office, or hospital settings, which should be local to you. 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. 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 will cover inpatient hospital stays, home health visits, skilled nursing facilities, and hospice. But, Part A costs will apply for these services. Further, patients who require hospital quarantine when they would otherwise be discharged won’t need to pay an additional deductible.
Finally, Part B 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. 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 consider COVID a pre-existing condition? Again, it’s possible. That’s why it’s important to sign up for Medigap 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 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 much as Medicare. So, like Original Medicare, 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 – 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 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.
Does 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.
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’s 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 is also requiring 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?
The CDC recommends the Pfizer-BioNTech and the Moderna COVID-19 vaccine.
At-Home COVID-19 Vaccinations for Medicare Beneficiaries
CMS is aiming to make it easier for high-risk individuals in group living situations, 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?
For immunocompromised individuals, 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. Like with the previous doses, this is at no cost to the beneficiary.
As COVID-19’s Delta and Mu variants emerge, many people seek extra protection from the virus. The booster shots will become more widely available to those without compromised immune systems in the near future.
Are Medicare Beneficiaries Comfortable Taking a COVID Vaccine?
Yes, more than half of Medicare beneficiaries feel comfortable receiving the vaccine.
FAQs
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.
