With the rapid changes associated with COVID-19 and healthcare services, Medicare beneficiaries may not have a good understanding of their portion of responsibility when it comes to paying for their healthcare services. With the impact of the pandemic, and the spread of this disease insurance companies and plans, such as Medicare, had to adjust. They reduced the patients’ cost share for certain services and increased coverage options for specific types of care, such as mental health and telehealth services.
When It Comes to COVID-related Services, What Does Medicare Cover?
Medicare helps cover COVID-related vaccines, treatments, and testing.
- Medicare Part B pays for the COVID-19 vaccines. As a beneficiary, you do not share the cost of your vaccination. Medicare fully covers the vaccine cost, leaving you with no out-of-pocket expenses.
- Currently, the Centers for Disease Control and Prevention (CMS) recommends the Pfizer-BioNTech (COMIRNATY) vaccine and the Moderna vaccine for COVID-19 prevention.
- The Centers for Disease Control and Prevention permits COVID-19 vaccines to be administered at the home of a Medicare patient if the patient suffers from severe mobility limitations or is homebound. Moreover, for CMS to cover the cost of the vaccination at home, the patient must live in a multi-resident setting. The aim is to help high-risk beneficiaries, including those who live in group settings, such as assisted living facilities, to receive their vaccinations.
- Medicare also covers a COVID-19 booster shot, which is an additional dose of the vaccine. The booster shot is the same dosage as the patient’s original COVID-19 vaccination. However, it helps better defend the patient’s body against becoming ill with COVID-19.
- Medicare permits different vaccines to be mixed and matched. Thus, the booster shot may be made by a different manufacturer.
Medicare does cover treatment for COVID. However, unlike with COVID vaccines, the beneficiaries do share in the cost. Still, Part A and Part B of Medicare have expanded their benefits due to COVID.
Here are a few examples of the expanded Part A coverage for COVID-related treatment:
- Private rooms for quarantine. Although Medicare usually pays for a semi-private room, a COVID patient may require quarantine. In response, Medicare would pay for a private room without the patient incurring any additional costs. The cost-sharing for a semi-private room would still apply.
- Extended hospital stays due to quarantine. If a beneficiary must remain quarantined in the hospital when they would typically have already been discharged, the patient is not responsible for the deductible charges that are related to the extended, quarantined stay.
- No 3-day hospital stay requirement before skilled nursing care. Medicare no longer requires a three-day hospital stay before covering skilled nursing facility care if the patient’s care situation was impacted by the COVID-19 pandemic. Available hospital rooms may be limited due to the increase in COVID-related hospitalizations, and some patients need to be moved to other facilities early, even though they do not have COVID.
- No benefit-period requirements for skilled nursing care. Usually, during each benefit period, Medicare Part A pays for up to 100 days of skilled nursing services. Each benefit period starts at the time of your hospital or skilled nursing facility admission and ends 60 days after your discharge. After the end of your benefit period, Medicare covers an additional 100 days of care in a skilled nursing facility. If the public COVID emergency has prevented the ending and starting of your benefit periods, Medicare will cover the additional 100 days of care without the benefit-period requirements.
In addition to Part A services, Medicare Part B helps pay for outpatient services that are COVID-related. These services continue to include transportation by ambulance, doctors’ visits, and emergency room care. However, after Medicare has paid its portion, beneficiaries are responsible for their coinsurance and deductibles unless they have Medigap coverage.
COVID-related Part B coverage changes include:
- COVID-19 monoclonal antibodies. The antibody treatment may be covered if the patient is COVID-positive and has symptoms that are mild to moderate but are at risk of developing a severe case of COVID.
- Remote services. Medicare extended its telehealth coverage during the pandemic. Virtual visits through telehealth are available even while you are at home. Telehealth is also available for hospice and home health care.
- No video requirement for some telehealth services. Services for behavioral health, health evaluations and management, and counseling for opioid treatment can be conducted using audio alone.
When COVID-19 testing is performed in a doctor’s office, pharmacy, hospital, or laboratory, Part B of Medicare covers the service.
- There is no out-of-pocket cost for you if you are a Medicare beneficiary.
- Medicare also covers testing at other locations, such as temporary testing sites.
- In some instances, Medicare also pays providers, such as lab technicians or home health nurses, to collect your sample at your residence for testing.
Does Medicare View COVID as a Pre-existing Condition?
For many insurance companies, COVID is considered a pre-existing condition. It is important to understand this when it comes to your plan:
- Original Medicare, as a federally funded health plan, provides coverage for people who suffer from pre-existing conditions. If Medicare deems COVID pre-existing, the determination may expand certain benefits.
- Medicare Supplement plans help cover out-of-pocket costs associated with pre-existing conditions. Therefore, many beneficiaries are concerned about whether Medigap will consider COVID pre-existing.
- Thus, Medigap may be able to help pay the coinsurance and deductibles of people who have had COVID.
Are the COVID-related Changes to Medicare Coverage Permanent?
In January 2020, the Secretary of the Department of Health and Human Services (HHS) declared a Public Health Emergency (PHE), which is a 90-day state of emergency that can be renewed to keep it in place. The COVID-19 PHE has been renewed multiple times and is set to expire in July 2022 unless it is renewed again.
The COVID-related changes to Medicare’s coverage may expire in relation to the expiration of the PHE.