Medicare Coverage and COVID-19: What Seniors Need to Know to Stay Protected

Since the COVID-19 pandemic hit in early February 2020, we’ve learned a lot about how it spreads, how to avoid it, and how to treat it. We’ve also learned that the older adult population is most susceptible to catching it, and most likely to require hospitalization when infected.

Costs associated with testing and treatment of Covid-19 are not insignificant and more than 60 million seniors over 65 rely on Medicare as their primary or only source of health insurance. But what does Medicare actually cover related to Covid-19?

The short answer is that it covers quite a lot thanks to some emergency federal legislation that has expanded Medicare coverage. Seniors should not be afraid of getting tested, more than once if necessary, getting required medications, or going to the hospital if needed. There are just a few things you need to keep in mind.

Coronavirus testing

If you believe you have been exposed to the virus, or are experiencing symptoms, you should get tested right away. Because of the national emergency, a provision in the Families First Coronavirus Response Act also eliminates beneficiary cost sharing for Covid-19 testing-related services, including the associated physician visit or other outpatient visits (such as hospital observation, E-visit, or emergency department services).

Thus, Medicare will fully cover the laboratory test for Covid-19, as well as the antibodies test. No deductible, coinsurance or copayment will be required. Furthermore, this benefit is available to both Original Medicare and Medicare Advantage Plans.

In many areas of the country, tests are still difficult to obtain, requiring advanced scheduling, long lines, and long waits for results. If you opt for certain kinds of private lab testing, you should know that Medicare MAY NOT cover it. Always check with your test provider before ordering these tests.

Necessary hospitalization and respirators

Hospitalizations deemed “medically necessary” will normally be covered under Medicare. But during the current pandemic, even patients diagnosed with mild cases of Covid-19 that require hospital quarantine as a precaution will be covered. The patient is still responsible, however, for paying any copays, hospital deductibles, or coinsurances that may apply to their treatment. This requirement has not been waived for Covid-19 related illness.

Should a senior need to be put on a respirator for Covid-19 treatment, those costs are covered.

Prescription Refills

Medicare Advantage and Part D plans must cover up to a 90-day supply of the patient’s prescription. During the pandemic however, for drugs covered under Part B, Medicare and its contractors can make decisions locally and on a case-by-case basis as to whether to provide and pay for a greater-than-90 day supply of drugs.

Online check-ins and other virtual health benefits

Also known as a telehealth service, seniors can actually have a complete visitation with their healthcare provider using a device that administers audio and video (i.e. smartphones, tablets, Zoom, Skype, etc.). In the past, Medicare would only cover telehealth services in certain situations. At this time Medicare has expanded its coverage to accommodate all members.

According to medicare.gov, people under Medicare “will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling, and preventive health screenings without a copayment.”

Are there special rules for Medicare coverage for skilled nursing facilities or residents around COVID-19?

Because of the coronavirus pandemic, CMS is waiving the requirement for a three-day prior hospitalization for coverage of a skilled nursing facility (SNF) for those Medicare beneficiaries who need to be transferred as a result of a coronavirus related disaster or emergency. For beneficiaries who may have recently exhausted their SNF benefits, the waiver from CMS authorizes renews SNF coverage without first having to start a new benefit period.

Nursing home residents who have Medicare coverage and who need inpatient hospital care, or other Part A, B, or D covered services related to testing and treatment of coronavirus, are entitled to those benefits in the same manner as community residents with Medicare.

To keep informed with the most up-to-date information regarding Medicare and the coronavirus, please visit medicare.gov.

An ounce of prevention

While it’s good to know that Medicare has you covered on coronavirus related care, it would be better to take a little advice from Ben Franklin and not need it at all.

Take extra steps to protect yourself or your senior loved ones by following all the best and latest science around prevention. Wash your hands and face during the day. Avoid crowded gatherings and maintain social distance. Always wear a mask. Stay safe and healthy and you won’t need to do all that Medicare paperwork!

At United Methodist Communities (UMC) at Pitman NJ, the health and safety of each resident is our first priority. Our team of medical and non-medical professionals work together daily to provide each resident with a specialized care plan. We know this focus is central to the joyful fulfillment of our 100+ year legacy to help New Jersey’s senior citizens.

To learn more about UMC’s assisted living community in Gloucester County, please visit our website: https://pitman.umcommunities.org/. Contact us today to book a virtual visit with our Pitman sales team.