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With the COVID-19 pandemic in full force, many may have questions about what COVID-19 related medical services are covered by their health insurance. Seniors, who are more vulnerable to serious complications from the virus because of higher rates of chronic illness, may especially be wondering what Medicare covers for COVID-19? At the basic level, Medicare covers all medically necessary hospitalizations, including those for COVID-19 infections but there is much more to discover.
What does Medicare cover for COVID-19 related health needs?
Medicare covers any lab tests for COVID-19 without any out-of-pocket costs.
Medicare covers any FDA-authorized COVID-19 antibody (or “serology”) tests if the Medicare recipient is diagnosed with a known current or known prior COVID-19 infection or a physician suspects a current or past COVID-19 infection.
Medicare covers all medically necessary hospitalizations, including hospitalizations for COVID-19 treatment or quarantine. Patients are required to pay for any hospital deductibles, copays, or coinsurances that apply.
If and when a vaccine for COVID-19 becomes available, it will be covered for Medicare recipients.
Note that kupuna who have chosen a Medicare Advantage Plan are able to access all of these same benefits and possibly more. For example, many Medicare Advantage Plans offer services such as medical transport and extra telehealth benefits.
Medicare is allowing Medicare Advantage Plans to waive cost-sharing for COVID-19 lab tests.
Telehealth services for COVID-19
Medicare already offered telehealth services that allowed Medicare recipients to receive some medical or health services such as office visits, psychotherapy, and consultations provided by a qualified health care professional over an interactive two-way telecommunications system. As of March 6, 2020, Medicare has temporarily expanded this service due to Coronavirus to allow medical and other providers such as licensed clinical social workers to use telehealth to provide services to treat COVID-19 and other medically reasonable needs. Medicare is also now allowing the services to be provided from offices, hospitals, and places of residence such as nursing homes and a wider range of devices is approved for use including audio-only phones. The idea is that reducing in-person health care visits can help prevent the spread of COVID-19.
Note that as before, coinsurance and deductibles may apply but those with Original Medicare will not pay a co-pay. Seniors with Medicare Advantage Plans may have more telehealth services covered in their benefit plans.
Medicare also pays for patients to communicate with their doctors using online patient portals without an in person visit to the doctor’s office.
Additional services offered because of COVID-19
Medicare is now allowing hospitals to provide medically-necessary hospital care in non-hospital settings to ensure that everyone who needs hospital care at this time can receive it. This includes off-site screenings.
Some Medicare Advantage Plans and prescription drug plans are waiving or relaxing prior authorization requirements.
Some requirements are being waived for skilled nursing facility care.
For a complete list of what Medicare covers for Covid-19 and how the CDC is providing information to help prevent the spread of the virus in nursing homes and elsewhere, click here.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.