Experts say that older adults are more prone to developing COVID-19 since their immune systems are suppressed. Older adults are most at risk for developing severe complications from COVID-19. Because of this, the rate of hospitalizations due to COVID-19 also increases by age.
If you’re a Medicare beneficiary, understanding how Medicare covers COVID-19 testing and treatment will prepare you for what you might pay if you were to develop COVID-19.
COVID-19 testing with Medicare
To test for COVID-19, an oversized cotton swab is used to obtain a test sample from the back of your nasal passage and sometimes your throat. There is also a less invasive testing available now that involves simply holding the swab in your nostril for about 15 seconds. That sample is then tested to verify whether you have been infected by the coronavirus. These tests can be performed at a pharmacy, doctor’s office, lab, hospital, parking lot, and in some circumstances, your home.
Medicare Part B covers your COVID-19 test at 100%. If you receive the test in one of the Medicare-approved locations mentioned above, you pay nothing out of pocket for this test. Medicare Part B also covers a COVID-19 antibody test and detects whether you’ve been infected by the virus in the past or not.
COVID-19 treatment with Medicare
If you test positive for COVID-19, your treatment plan will depend on various factors, such as your pre-existing conditions and the severity of your symptoms. The most common treatment plan is to quarantine at home for two weeks. However, if your doctor recommends hospitalization, Medicare Part A will cover it.
Part A will cover your room and board while you’re in the hospital. Medicare Part B will cover your doctor and nurse services. While your COVID-19 test is covered at 100%, your hospitalization and treatment are not. Ordinary Medicare cost-sharing applies, including your Part A deductible and Part B coinsurance.
Your Part A deductible will cover your first 60 days as an inpatient at 100%. As of 2020, the Part A deductible is $1,408. If you remain in the hospital for longer than 60 consecutive days, you will also be responsible for a daily copay.
You will also be responsible for your Part B deductible and 20% coinsurance for any Part B services you receive while in the hospital. A COVID-19 stay at the hospital could easily cost several thousand dollars out-of-pocket unless you have a Medicare Advantage or Medigap plan.
COVID-19 coverage with a Medigap or Medicare Advantage plan
Medigap and Medicare Advantage plans are voluntary plan options that can help lower your out-of-pocket costs while on Medicare. These types of plans work differently from each other, so it’s essential you learn the pros and cons of each before enrolling.
Medigap plans pay secondary to Original Medicare, and therefore, only pay if Medicare first approves the claim. If Medicare doesn’t cover a service, neither will your Medigap plan. Medigap plans pay expenses such as your Part A deductible and coinsurance and Part B coinsurance. For example, with a Medigap Plan G in the hospitalization scenario above, you’d only be responsible for the $198 Part B deductible.
Medicare Advantage plans
Medicare Advantage plans, on the other hand, replace Original Medicare. Your deductibles, copays, and coinsurance depend on your plan specifics. For example, instead of having a $1,408 hospital deductible, you may have a $300 daily copay for days 1-5, and then your days beyond day five are covered at 100%.
Medicare Advantage plans are required to cover you as well as Original Medicare, meaning you will never have less coverage with a Medicare Advantage plan than you would with Original Medicare. A big bonus to having a Medicare Advantage plan is that you have a maximum out-of-pocket limit each year. There is no cap to your spending if you only have Part A and Part B.
As you can see, Medicare covers COVID-19 treatment like any other medically necessary service. However, COVID-19 testing is covered at 100%, whereas most diagnostic testing is only covered at 80%, which is good news for all Medicare beneficiaries.
Medicare also covers telemedicine services now for all beneficiaries. Therefore, if you want to stay home instead of going to the doctor’s office or clinic, Medicare Part B will pay for the visit. This coverage will continue as a standard Medicare benefit. Medicare has taken extra steps to make sure everyone is covered for care during the COVID pandemic.