According to the Centers for Disease Control and Prevention (CDC), older adults and people who have severe chronic medical conditions like heart, lung, or kidney disease are at risk for more serious COVID-19 complications. This means that most people with Medicare are at higher risk and potentially subject to higher costs. Senior65.com has received many requests to explain how Original Medicare, Medigap (Medicare Supplement) and Medicare Advantage (MA) step in to help seniors during this pandemic.
How does Medicare cover Coronavirus?
Although the vast majority of people recover from the coronavirus without hospitalization or medical care, here are the COVID-19 costs covered by Medicare.
- Medicare covers lab tests for COVID-19. You pay no out-of-pocket costs. Your doctor or other health care provider must request the test.
- Medicare covers all COVID-19 related hospitalizations after you pay the Part A deductible. This includes if you’re diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine. If you don’t have additional coverage beyond basic Medicare, like Medigap, you will need to pay a $1,408 Part A deductible plus the 20% that Medicare does not cover for a hospital stay.
- Medicare covers 80% of COVID-19 related doctor visits after Part B deductible. Medicare Part B has a $198 deductible and beneficiaries typically pay 20% of covered services.
- Eventually COVID-19 vaccines will be covered under Medicare Part D. While at this time there is no vaccine for COVID-19, Original Medicare Part A and B will not cover vaccines. The Center for Medicare Services states that vaccines are to be covered by Medicare Prescription Drug Plans (Part D). There is no word yet if they will be subject to deductibles and/or copays.
It is important to review Medicare Part A coverage as we look at potential costs associated with COVID-19. Below is a quick summary:
- Hospitalization Days 61-90: $352 per day per day
- Hospitalization Lifetime Reserve Days: 60 days at $704 per day per day
- Skilled Nursing Facility: 80 days at $176 per day
Also worth noting is that Medicare had some telehealth services covered before the pandemic, but now these services are expanded. You will be able to interact with a wide range of health care providers such as doctors, psychologists and nurses through communication tools such as smartphones and desktop computers. This can include evaluation, health screenings and even mental health counseling .
How does Medigap cover the Coronavirus?
As you may know, Medigap is supplemental insurance to Medicare. Medigap plans help you cover much of what Medicare does not. A person with Medigap Plan G should find that most of the COVID-19 treatments discussed above would be covered after they satisfied the Part B deductible. Medigap Plan G covers:
- 100% Part A Deductible
- 100% Days 61-150 of a hospital stay
- Up to $176 per day for days 21-100 of Skilled Nursing Facility
- 100% Part B Excess Charges
There are many Medigap plans available so check our Medigap’s Most Popular Plans to learn more.
How does Medicare Advantage cover Coronavirus?
Medicare Advantage (MA) plans are offered by private companies that provide the same coverage as Original Medicare. The main difference is that these plans usually have some more benefits, but it all depends on the plan. In this case it is highly important to point out that Medicare Advantage plans sometimes cover drugs like a Part D plan. This means that when a vaccine finally arrives, MA plans may cover it.
Like Medicare, some Medicare Advantage plans have also decided to expand their variety of telehealth services to prevent the spread of the coronavirus in the country.
The Center for Medicare and Medicaid Services (CMS) has declared that individuals meeting the requirements listed in the original COVID-19 SEP announcement can enroll, dis-enroll, or switch Medicare Advantage and Part D plans until June 30, 2020.
If you are planning to get a Medigap or Medicare Advantage plan, you should know that many insurance providers are making exceptions to expand coronavirus treatment. One provider recently announced that all costs related to subsequent treatment for COVID-19—including inpatient hospital admissions— will be waived for enrollees of Medicare Advantage and Medicare Supplement plans. Please contact us to discuss which providers have expanded coverage.