The coronavirus disease that has overwhelmed individuals across the globe since early 2020 is also known as COVID-19. The virus is airborne, meaning it is transmitted through respiratory droplets in close contact and can cause severe respiratory symptoms, even death. According to the Centers for Disease Control and Prevention (CDC), older adults and people with severe chronic medical conditions are at a higher risk of developing more severe symptoms. Medicare is government insurance available to older adults, so most Medicare beneficiaries are considered high risk. For others, mild symptoms may include fever, cough, fatigue, or headache.

Understanding Medicare coverage is essential during this pandemic, with the number of hospitalizations fluctuating and deaths and cases still rising.

COVID-19 tests

If you are a Medicare beneficiary, you will pay nothing for a COVID-19 test when you get it from a laboratory, hospital, pharmacy, or doctor. Medicare covers testing at 100% under Part B. The deductible or any coinsurance is not required to be paid. The same is for the antibody or “serology” test, which helps you see if you have developed immunity to the virus, thus putting you at less immediate risk of becoming reinfected.

Original Medicare coverage for treatment

Medicare will cover all COVID-19 treatment that is considered medically necessary. The parts of Medicare that the treatment will fall under will depend on where the treatment is performed. During this pandemic, Medicare also established new codes so providers can correctly bill for services related to the virus.

Part A coverage

Medically necessary hospitalizations for COVID-19 will be covered by Part A of Medicare. If you are an inpatient in the hospital, there will be a $1,484 deductible per admittance. There is a $0 copay per day for days 1-60, but from days 61-90, the copay is $371. If you are still in the hospital due to the virus after 90 days, you will pay $742 per day for lifetime reserve days.

Medicare will also cover inpatient stays, even when you should be medically discharged if you need to stay for quarantine purposes. In that situation, an additional deductible would not be required.

Part B coverage

Medicare Part B has a $203 annual deductible before paying 80% of Medicare-approved medical services. Diagnoses, procedures, and tests for COVID-19 completed in an outpatient setting such as a laboratory or doctor’s office would be covered under Part B.

The monoclonal antibody treatment is an infusion that includes specific antibodies to treat COVID-19. This treatment is covered 100% by Medicare Part B when received from a Medicare provider or supplier. You do not have to reach the deductible or pay coinsurance for this treatment. However, the treatment is covered if all of these apply:

• You tested positive for COVID-19.
• Your case is mild to moderate.
• You are at higher risk of progressing to a severe case or hospitalization.

The costs you are responsible for will depend on the additional coverage you may have with Original Medicare.

Additional coverage

The benefits provided by Original Medicare will also be the same whether the additional coverage is a Medigap plan or Medicare Advantage plan. However, the cost-sharing will vary.

Medigap plans, also known as Medicare Supplements, are secondary to Original Medicare. These plans always pay after Medicare pays and will fill the Medicare gaps, leaving you with little out of pocket. If the provider accepts Medicare, they must accept your Medigap plan as well. For instance, the Medigap Plan G will cover the hospital deductible and copays/coinsurance for you. You would have 100% coverage between Medicare Part A and Plan G. Medicare Part B pays 80% of medical services approved by Medicare, and Plan G will cover the 20%. The only amount the Plan G does not pay for you is the $203 annual deductible.

Medicare beneficiaries may have a Medicare Advantage plan instead of a Medigap plan. These plans are network plans. Even though you still have Original Medicare, you will receive the same benefits through the Medicare Advantage plan. You are required to use a network of doctors and hospitals. Each service will have a set copay or coinsurance, so an inpatient hospital stay will have a daily copay. Each doctor visit or lab work procedure will have a copay. The cost-sharing with each plan will vary. According to the Centers for Medicare and Medicaid Services (CMS), some Medicare Advantage plans are waiving cost-sharing for treatments related to COVID-19, although it is not required.

Now that the FDA has approved two COVID-19 vaccines, Medicare Part B will cover the COVID-19 vaccine at no cost to the beneficiary, and that applies to those with Medicare Advantage plans as well.

Conclusion

Avoiding unnecessary travel and interactions with large groups, staying at least six feet away from others, and consistently washing your hands is highly recommended by the CDC. Following CDC guidelines can lower your chances of contracting the virus. However, it is wise to understand how Medicare will cover you in COVID-19 related situations.