So many questions surround COVID-19 or the coronavirus. There are many uncertainties surrounding this illness especially when it comes to health care coverage. Medicare recipients, in particular, may ﬁnd themselves wondering what Medicare covers when it comes to health care related to COVID-19. This guide explains what original Medicare will cover when it comes to testing and related treatment for this virus and what costs you will have to cover.
Medicare Part B is the part of your insurance that covers testing for COVID-19. In this instance, testing refers to a few different types of medical testing. First, Medicare will cover the cost of a COVID-19 diagnostic test. This means that you will not be charged for the cost of testing. However, your doctor must order the test in order for it to be covered. You will need to meet certain criteria for the doctor to order a test. If you have to go to a separate facility to get tested, that facility might have additional criteria you may need to meet as well.
Your doctor will also use other types of tests to help them determine if you have an illness other than COVID-19. Tests like these include CT scans. These types of tests will have a cost to them. If you have already paid the 2020 yearly deductible of $198, expect to pay approximately 20% of the total cost.
Care in the Hospital
Costs related to a stay in the hospital are top-of-mind for people generally speaking because of the higher costs involved. Care services you receive in the hospital include:
- The hospital room you stay in
- Your meals
- Medications you are on in the hospital
- Supplies (masks, needles, dressings, swabs, etc…)
- X-Rays, CT scans and other types of image testing
- Nursing care
These services are billed to Medicare Part A and are subject to a beneﬁt period. Simply put, your beneﬁt period is the day you are admitted to the hospital and ends when you are discharged. For the ﬁrst two months or 60 day of a hospital stay, the deductible paid is $1408 and you do not need to pay a co-pay. This deductible is paid for every hospital stay you have.
Medicare recipients pay $352 per day for the third month of a hospital stay. After 90 days, recipients must pay all costs after 90 days. However, if you have lifetime reserve days left, each person gets 60 of these, the lifetime reserve days can be used towards a hospital stay.
Quarantine in the Hospital
Medicare will cover the cost of your hospital stay even if you are required to be in a quarantined room and will not require an additional deductible if the stay goes beyond the 90 day beneﬁt period due to quarantine. In fact, the hospital is not allowed to charge you the difference between being in a private room and a semi-private room if it’s because of a quarantine.
No vaccine is currently available for COVID-19. However, if and when one is made available, Medicare will cover the cost.
Medicare has expanded telehealth medical visits via a tablet, computer, or other device due to COVID-19. With telehealth, you can see your doctor or nurse practitioner for routine ofﬁce visits, preventative care, and evaluations without paying a co-pay. Check-in virtual visits are also covered. These are communications with your doctor or nurse practitioner not related to a visit within the last 7 days or that prompt an appointment within 24 hours or the soonest available appointment. You must agree to a telehealth visit in order to get one and the doctor or nurse practitioner has to document in your chart that you had these visits
Medication supplies over 60 days may be covered on a case by case basis depending on the circumstances for COVID-19 in your area.
Other Things to Consider
The topics covered here include the costs for original Medicare only. Your actual total costs for treatment during the COVID-19 out of pocket will depend on whether or not you have supplemental insurance or Medicare Advantage.
Scams are also on the rise during the COVID-19 pandemic Make sure to review Medicare statements you receive carefully to ensure that they are accurate. And never give your medicare number over the phone if someone calls asking for it.