Medicare and Coronavirus: Coverage for Telehealth, Testing, and Vaccines
Medicare has temporarily expanded some of its services to respond to the COVID-19 pandemic. The most significant changes include telehealth services and coronavirus disease testing.
If you have a Medicare Supplement, your out-of-pocket costs will be lower. If you have a Medicare Advantage (MA) plan, you have access to the same benefits as Original Medicare. Medicare has allowed MA plans to waive cost-sharing for COVID-19 lab tests. Many MA plans also offer additional telehealth benefits beyond the ones we’re going to describe.
That said, here’s what you need to know about Medicare coverage during the coronavirus disease pandemic.
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Medicare Telehealth During COVID-19
Medicare has been working towards more telehealth coverage for a while now – especially in rural areas. But with COVID-19, the Centers for Medicare & Medicaid Services has temporary broadened access for everyone under the President’s emergency declaration (CMS.gov).
In addition to the current telehealth covered services, Medicare has expanded the where, how, and who of telehealth. For example, you can now get telehealth services at home from your smartphone. You can also get help from a wide range of medical professionals, including doctors, nurses, psychologists, and social workers.
You can also get help with a variety of services through telehealth including:
- Common office visits
- Mental health counseling
- Preventive health screenings – with no copays if you have Original Medicare
The goal behind offering telehealth from your home is to keep you from visiting doctor’s offices or the hospital, which could put you or others at risk of exposure to COVID-19.
Three Ways to Get Telehealth Services
You can get virtual service from your healthcare provider in three ways:
- Medicare telehealth visits: a virtual alternative to a typical in-person office or hospital visit; for new or established patients.
- Virtual check-ins: a brief communication with your practitioner; can be a phone call, video call, or even an image, but the concept here is that the interaction is very brief; for established patients.
- E-visits: a non-face-to-face patient-initiated conversation with your doctor through an online patient portal; for established patients.
Your standard Part B cost-sharing applies to all of these telehealth services. If you have a Medicare Supplement, you’ll be responsible for very little or no out-of-pocket costs.
CMS says that you may pay less for telehealth services right now as the “HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs” (CMS.gov).
Medicare COVID-19 Lab Testing
Medicare covers lab testing for the COVID-19 virus. There are no out-of-pocket costs if you’re able to get tested.
Keep in mind that testing isn’t widely available right now, so you will probably only get tested if you’re hospitalized or have a severe case. Patients with severe cases need supplemental oxygen. About 6% of cases become critical, which means the patients develop septic shock that can lead to stroke, heart or respiratory failure, failure of other organs, or death.
Rest assured that 80% of laboratory-confirmed cases of COVID-19 cases exhibited mild to moderate symptoms (Wexner Medical Center at Ohio State University).
The most common symptoms of COVID-19 are:
- 100.4 fever or above
- Body aches
- Dry cough
- Shortness of breath
Any shortness of breath combined with other symptoms should be immediately checked out by a doctor.
COVID-19 Vaccine Medicare Coverage
There is currently no vaccine for the coronavirus disease. However, if one becomes available, all Medicare Part D drug plans will cover it.
Anthony Fauci, National Institutes of Allergy and Infectious Diseases Director, stated it would take at least a year to approve a COVID-19 vaccine. On a hopeful note, one potential vaccine, developed by Moderna and the US government, is already in the midst of a clinical trial in Seattle.
According to The Scientist, The Coalition for Epidemic Preparedness Innovations (CEPI) has invested $30 million in several different vaccine candidates. CEPI plans to advance the top six candidates into more extensive efficacy trials with thousands of participants.
On a larger scale, the Biomedical Advanced Research and Development Authority (BARDA) is giving hundreds of millions of dollars to two top vaccine candidates:
- Johnson & Johnson’s Janssen division
- Moderna, in collaboration with the US government
These funds would be used for putting the potential vaccines through clinical development and gearing up for the manufacturing process.
Medicare and COVID-19 Hospitalizations
Medicare covers all medically necessary hospitalizations. 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, Medicare will cover it.
If you don’t have a Medicare Supplement, a 5-day hospital stay would regularly cost you the Part A deductible of $1,408. According to research cited by The American Journal of Managed Care, the same hospital stay for a Medicare Advantage enrollee would cost $1,200 in out-of-pocket costs.
Those costs are pretty high, but the Trump administration has implemented a policy that allows health plans to reduce or even eliminate cost-sharing for COVID-19 testing and treatment:
“The Medicare program and several health plans have committed to provide this coverage with zero out-of-pocket costs during the pandemic; some plans have gone further and will waive out-of-pocket costs for COVID-19–related hospitalizations.”
If you’re unsure about your hospitalization coverage during COVID-19, ask your provider.
Need Medicare Help?
The coronavirus pandemic has caused a lot of uncertainty, but we see Medicare stepping up to make sure seniors get the healthcare coverage they need. It’s very encouraging.
Our Medicare experts are standing by to answer your questions. If you have any concerns about your health coverage, particularly during this trying time, get in touch. Give us a call at 833-801-7999!
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