Does Medicare Cover Testing for COVID-19?

According to the Centers for Medicare and Medicaid Services, any American with Medicare Part B, including those enrolled in a Medicare Advantage plan, have access to FDA approved over-the-counter COVID-19 tests at no cost. You can get up to 8 tests every month from participating pharmacies and healthcare providers during the COVID-19 emergency.

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Does Medicare Cover COVID-19 Treatment?

Medicare covers inpatient hospital stays, skilled nursing facility stays, hospice care under Part A, and some home health visits. If you require inpatient hospitalization for COVID-19 treatment, this treatment will be covered for Medicare beneficiaries. Beneficiaries who need post-acute care after their hospitalization have coverage, but Medicare does not cover long-term services and supports, such as extended nursing home stays.

Covid-Related Items and Services Covered By Medicare

In relation to COVID-19, Medicare covers:

  • FDA-approved COVID-19 vaccines.
  • COVID-19 lab tests.
  • Over-the-counter COVID-19 tests.
  • FDA-approved COVID-19 antibody tests.
  • Monoclonal antibody treatments for COVID-19.
  • Medically necessary hospitalizations for COVID-19 (you still pay for any hospital deductibles, copays, or coinsurance that applies).
  • Telehealth services, expanded during the public health emergency.

Getting A Vaccine At Home

If you have a disability or face other challenges that prevent you from leaving your home to get the COVID-19 vaccine, Medicare will pay for a doctor or care provider to give you the COVID-19 vaccine in your home. You may need to provide your Medicare number for billing, but you will pay no cost for the vaccine or its administration. Contact your healthcare provider to see if you are eligible to receive your COVID-19 vaccine at home. (source)

How Much Do You Pay For Covid Treatment With Medicare?

If you have Medicare Part A, you will be subject to hospital deductibles and daily copayments for extended inpatient hospital and nursing facility stays. If you need to be quarantined in the hospital, you will not be required to pay an additional deductible.

For outpatient services covered under Medicare Part B, 20% coinsurance applies to most services, but there is a deductible you will have to pay, for things like physician visits and ambulance transportation. For the COVID-19 monoclonal antibody treatment, Medicare beneficiaries pay no cost and deductibles do not apply.

If you do not have supplemental coverage, such as Medigap, retiree health benefits, or Medicaid, you will be at a greater risk of paying high out-of-pocket medical expenses. Medicare does not have an out-of-pocket limit for services covered under Medicare Parts A and B. Medicare Advantage plans often charge daily copayments for inpatient hospital stays, emergency room services, and ambulance transportation.

What To Do If You Paid To Get A Covid Vaccine

Your provider currently cannot charge you for an office visit or any other fee if you are simply going in to receive your COVID-19 vaccine. If you receive other medical services at the same time that you get the vaccine, you may owe a copayment or deductible for those services.

If you received a bill for a COVID-19 vaccine, you need to:

  • Check the receipt and statement you get from your provider for any mistakes.
  • Call your provider’s office about charges you believe to be incorrect.
  • Review your “Medicare Summary Notice” if you have Original Medicare, or report anything suspicious to Medicare by calling 1-800-MEDICARE.
  • Review your “Explanation of Benefits” if you have other coverage, such as a Medicare Advantage Plan. Report anything suspicious to your insurer.
  • If your provider charged you and is refusing to get rid of the charge, contact the Office of the Inspector General at the US Department of Health and Human Services by calling 1-800-HHS-TIPS or visiting TIPS.HHS.GOV.

Medicare Coverage of Covid-19 Vaccines and Boosters

Medicare Part B covers an FDA-approved vaccine for COVID-19 with no cost sharing for Medicare beneficiaries, and this applies to beneficiaries of both traditional Medicare and Medicare Advantage plans. Currently, the FDA approves COVID-19 vaccines from Pfizer-BioNTech, Moderna, and Janssen, as well as boosters for Pfizer and Moderna.

Medicare Coverage for Skilled Nursing Facilities or Nursing Home Residents

The CMS has waived its requirement for a 3-day proper hospitalization for coverage of a skilled nursing facility for Medicare beneficiaries who need to be transferred due to a disaster or emergency. Nursing home residents who have Medicare coverage and need inpatient hospital care, or other services related to treatment of COVID-19, are entitled to those benefits in the same manner that residents with Medicare are.

Medicare has also issued guidance to help stop the spread of COVID-19 in nursing facilities.

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