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How does Medicare cover COVID-19 (Coronavirus disease 2019)?

As noted on the Medicare website, the Centers for Medicare and Medicaid Services (CMS) current guidance on coverage related to the novel corona virus COVID-19 is as follows:
  • Medicare covers FDA-authorized COVID-19 vaccines - be sure to bring your Medicare card when getting your vaccine.  You pay no out-of-pocket costs.

  • Medicare Part B (and Medicare Advantage plans) cover the lab tests for COVID-19 "when you get it from a laboratory, pharmacy, doctor, or hospital, and when Medicare covers this test in your local area"You pay no out-of-pocket costs.

  • Medicare covers FDA-authorized COVID-19 antibody (or “serology”) tests if you were diagnosed with a known current or known prior COVID-19 infection or suspected current or suspected past COVID-19 infection.

  • Medicare Part B (Medical Insurance) covers a COVID-19 monoclonal antibody treatment, if all of these apply:
    • You tested positive for COVID-19.
    • You have a mild to moderate case of COVID-19.
    • You’re at high risk of progressing to a severe case of COVID-19 and/or at high risk of requiring hospitalization.
    You pay no out-of-pocket costs "when you get the treatment from a Medicare provider or supplier".

  • Medicare Part A (and Medicare Advantage plans) cover all medically necessary hospitalizations.
    This includes if you're diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.  You would pay your Medicare plan's deductible and cost-sharing as you would for any Medicare covered hospital stay.

  • If you have a Medicare Advantage Plan, you have access to these same coverage benefits.
    Medicare allows Medicare Advantage plans to waive cost-sharing for COVID-19 lab tests.  Many Medicare Advantage plans also offer telehealth benefits - and other expanded non-medical or supplemental benefits.  Check with your Medicare Advantage plan about your coverage and costs (the toll-free number for Member Services is found on your Member ID card).

  • Please remain cautious
    Scammers may use the coronavirus national emergency to take advantage of people while they’re distracted.  As always, guard your Medicare card like a credit card, check Medicare claims summary forms for errors, and if someone calls asking for your Medicare Number, hang up!  Also watch for people contacting you about telehealth appointments that you did not make or with doctors that you do not know.  You can report fraud by contacting a Medicare representative at 1-800-633-4227.

Telehealth & related services

Medicare has temporarily expanded coverage of telehealth services to respond to the current COVID-19 Public Health Emergency.  These services expand the current telehealth covered services to help you have access from more places (including your home), with a wider range of communication tools (including smartphones), to interact with a range of providers (such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social worker).

As noted by Medicare: your cost with Original Medicare is "20% of the Medicare-approved amount for your doctor or other health care provider’s services, and the Part B Deductible applies. For most telehealth services, you'll pay the same amount that you would if you got the services in person."

During this time, you will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. This will help ensure you are able to visit with your doctor from your home, without having to go to a doctor's office or hospital, which puts you and others at risk of exposure to COVID-19.

  • You may be able to communicate with your doctors or certain other practitioners without necessarily going to the doctor's office in person for a full visit. Medicare pays for “virtual check-ins”—brief, virtual services with your established physician or certain practitioners where the communication isn't related to a medical visit within the previous 7 days and doesn't lead to a medical visit within the next 24 hours (or soonest appointment available).

  • You need to consent verbally to using virtual check-ins and your doctor must document that consent in your medical record before you use this service. You pay your usual Medicare coinsurance and deductible for these services.

  • Medicare also pays for you to communicate with your doctors using online patient portals without going to the doctor's office. Like the virtual check-ins, you must initiate these individual communications.

  • If you live in a rural area, you may use communication technology to have full visits with your doctors. The law requires that these visits take place at specified sites of service, known as telehealth originating sites, and get services using a real-time audio and video communication system at the site to communicate with a remotely located doctor or certain other types of practitioners. Medicare pays for many medical visits through this telehealth benefit.
The Kaiser Family Foundation also added the following Medicare coverage points in March 2020:
  • "CMS has given guidance that in the case of a national disaster, emergency declaration, or public health declaration, CMS expects Medicare Part D plans (PDPs and MAPDs) to lift their "refill-too-soon" restrictions (edits) until the termination of the emergency declaration.  Therefore, during COVID-19, Medicare Part D plans may, but are not required to relax their refill rules.  Contact your Medicare Part D plan's member services if you need a prescription refill or an extended refill that would typically be denied due to "refill-too-soon" restrictions.   [And as noted by Medicare, "Medicare Advantage Plans and Prescription Drug Plans may waive or relax prior authorization requirements."]  [You can contact your plan's Member Services department using the toll-free number found on your Member ID card.] 

  • During the period of the declared emergency, if you are affected by the emergency, Medicare Advantage plans are required to cover services at out-of-network facilities that participate in Medicare, and charge you no more than you would pay if you had received care at an in-network facility.

  • Part D plans are required to ensure that you have adequate access to covered Part D drugs at out-of-network pharmacies when you cannot reasonably be expected to use in-network pharmacies. Part D plans may also relax restrictions on various methods of delivery, such as mail or home delivery, to ensure you have access to needed medications if you unable to get to a retail pharmacy.

  • In response to the national emergency declaration related to the coronavirus pandemic, if you need to be transferred to a skilled nursing facility (SNF) as a result of the effect of a disaster or emergency, CMS is waiving the requirement for a 3-day prior hospitalization prior to coverage. If you have recently exhausted your SNF benefits, the waiver from CMS authorizes renewed SNF coverage without first having to start a new benefit period."
Sources include:
https://www.medicare.gov/medicare-coronavirus 03/23/2020, 09/23/2020, 05/25/2021
https://www.kff.org/medicare/issue-brief/faqs-on-medicare-coverage-and-costs-related-to-covid-19-testing-and-treatment/ 03/19/2020  [with notes, links, and emphasis added]

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