Will Medicare Cover a COVID-19 Test?
COVID-19 is a new disease that has infected over 14 million people in the United States.[1] COVID-19 affects each age group differently. For example, 8 out of 10 coronavirus deaths have been senior adults age 65 or older, according to the Centers for Disease Control and Prevention (CDC).
Medicare has changed its coverage to ensure seniors can get the healthcare they need during the pandemic. Here’s what you need to know about Medicare and COVID-19 tests.
Medicare coverage for a COVID-19 test
There have been over 215 million COVID-19 tests performed in the United States. There are two tests used to detect the coronavirus: a swab or antibody test. The swab test can see if you have the coronavirus at that exact moment, while the antibody test detects COVID-19 antibodies, which means you have had the virus in the past and recovered.
If your doctor or healthcare provider orders a coronavirus test, Medicare Part B pays 100% with no deductible. Whether you have a Medicare Advantage plan or Original Medicare with a Medigap plan, you pay no out-of-pocket costs for a coronavirus test.
What if I test positive for COVID-19?
Many seniors who test positive for coronavirus have mild symptoms and are able to recover at home with outpatient care. Some, however, become quite ill and require hospitalization.
If you need outpatient care for COVID-19, Part B pays 80% of approved services. Medicare passed a rule in April allowing providers to waive coinsurance for telemedicine visits, so your doctor may not collect your 20% coinsurance for COVID care. You can ask about their coinsurance policy when you make a telehealth appointment.
Medicare Part A covers inpatient stays at the hospital or skilled nursing facility. Part A covers a semi-private room, meals, lab services, and medications. However, you have to meet the Part A deductible, which is $1,484 in 2021, before Medicare provides coverage. Once you have met the Part A deductible, you pay nothing for covered Part A services for the first 60 days. There is a daily copay of $371 for days 61 through 90.
Your doctor may recommend a stay at a skilled nursing facility once you are discharged from the hospital. Medicare Part A covers up to 20 days at a skilled nursing facility if you were a hospital inpatient for at least three days prior to admission to the facility. l. If your nursing facility stay lasts more than 20 days, you will have a daily copayment of $185.50 for days 21 through 100.
Medicare and COVID-19 vaccine
The FDA recently issued emergency use approval for the Pfizer-BioNTech COVID vaccine to be administered in the U.S. Other vaccines should be approved in the near future.
The coronavirus CARES Act passed in March includes provisions for Medicare and a COVID-19 vaccine. Under the legislation, Medicare Part B will pay 100% of the cost of the vaccine and the costs to administer it. The Part B deductible requirement is waived for COVID vaccines.
Summary
Handwashing, masks, social distancing, and testing all play a part in stopping the spread of COVID-19. If you’ve been exposed to the virus or experience symptoms, Medicare will pay for coronavirus testing and treatment. In addition, Medicare will pay 100% of the costs of the vaccine as soon as you are able to get it.
