Millions of Americans have contracted the novel coronavirus, leading to the COVID-19 outbreak. Scientists are working to develop a vaccine, and when it is available, Medicare will cover the full cost.
Medicare beneficiaries can be reassured to know that their coverage ranges from initial virus testing and extends to medically necessary hospitalizations relating to COVID-19.
The coverage includes prescribed medications and other therapeutic agents doctors use to treat the disease.
Researchers from the United States and other parts of the world are working to develop a vaccine, and, once the medication has proven to be safe and effective, Medicare will cover the entire cost.
This article discusses COVID-19 and an overview of Medicare coverage of the disease.
It also examines specific coverage of COVID-19 relating to the testing, hospitalization, and skilled nursing facility care, as well as telehealth treatment, medications, and vaccines.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
COVID-19 is a highly contagious infectious disease caused by the novel coronavirus.
Less common symptoms are gastrointestinal effects, such as diarrhea, nausea, and vomiting, along with an impaired sense of taste and smell.
At this point, doctors do not fully know the long-term effects. A study in the journal Frontiers in Neurology indicates the medical community has concerns that it may cause neurological problems. Also, the National Heart, Lungs, and Blood Institute suggest it may harm the heart.
Although researchers around the world are working on a vaccine for COVID-19, currently none are available. Different vaccine candidates are undergoing clinical trials, but the U.S. Food and Drug Administration (FDA) cannot predict how quickly the tests will generate enough data for a thorough evaluation.
The vaccine will be free to individuals whether they have original Medicare or a Medicare Advantage plan.
Some beneficiaries have original Medicare, which consists of Part A, hospital insurance, and Part B, medical insurance.
Part A covers healthcare a person receives as an inpatient for COVID-19, while Part B covers the healthcare someone receives as an outpatient.
While some individuals with original Medicare also have prescription medication coverage under Medicare Part D, at this time, the FDA has not approved any COVID-19 medications for outpatient use.
Those with Medicare Advantage, also known as Part C plans, will have the same benefits and coverage as those with original Medicare. Some Medicare Advantage plans also offer additional benefits, such as medical transportation or a meal delivery service.
Medicare covers two types of tests for COVID-19.
A COVID-19 lab test enables a healthcare provider to rule out or diagnose the disease. Along with this test, doctors may order tests for related conditions to help with diagnoses.
Medicare Part B covers these tests, and the coverage applies to people with original Medicare or those with Medicare Advantage.
There is no charge if the tests take place in a person’s local area, and the tests come from a pharmacy, lab, doctor’s office, or hospital.
Medicare may also cover testing in some pop-up sites in parking lots.
COVID-19 antibody test
The COVID-19 antibody test, sometimes called a serology test, determines whether someone has developed an immune response to the disease.
If they have, this means that they may not have an immediate risk of reinfection. Medicare Part B provides coverage, and a person pays nothing for this test.
For people with original Medicare or a Medicare Advantage plan, medically necessary hospitalizations are covered, including those for COVID-19.
After a hospital stay, some individuals may need to remain in the hospital for quarantine purposes, when typically, they may have been discharged. Medicare covers this, too.
Original Medicare out-of-pocket costs include:
- $1,408 deductible for each benefit period
- $0 copayment for days 1–60 of each benefit period
- $352 copayment per day for days 61–90 of each benefit period
- $704 copayment per day for each lifetime reserve day of each benefit period
A benefit period starts the day a person enters a hospital as an inpatient and ends the day after they have been home from the hospital for 60 days.
After a person has been in a hospital for 90 days, Medicare provides coverage of an additional 60 days, known as lifetime reserve days. A person may use these days only once in their lifetime.
The out-of-pocket hospitalization costs for Medicare Advantage plans vary according to the private insurance company administering the plan.
In response to the COVID-19 outbreak, Medicare has temporarily expanded coverage of telehealth services. The expansion gives individuals access to a broader range of advice from health practitioners without having to leave their homes. Practitioners may include doctors, clinical psychologists, and physical therapists.
The means of communication, covered by Medicare, includes virtual check-ins and online patient portals.
People who do not have access to interactive technology may also use a telephone.
When a doctor admits a person with COVID-19 to a hospital, they may prescribe the following therapeutic agents, which Part A covers.
Convalescent plasma is the liquid part of the blood taken from people who have recovered from COVID-19. It contains antibodies that may help fight the infection.
Remdesivir is an antiviral drug that may shorten recovery time.
During the COVID-19 outbreak, a person may have many questions or need advice they feel able to trust. Here are some reliable sources:
- The Medicare webpage provides information on all things coverage-related.
- The Centers for Disease Control and Prevention (CDC) and the Federal Emergency Management Agency (FEMA) authorize coronavirus.gov for COVID-19 information.
- The CDC website provides general facts about COVID-19.
- Information on the U.S. government’s response to COVID-19 can be found here.
Vaccines for COVID-19 are currently undergoing clinical trials.
Once the trials have generated enough data to show that a vaccine candidate is safe, and the drugs have been effective, the FDA will approve it.
When this happens, Medicare will cover the cost for all beneficiaries.
In the meantime, Medicare covers testing, telehealth, and hospitalization for people with the disease.
Individuals who wish to have more information may visit the CDC and other government websites.
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.