Is COVID testing & treatment covered by Medicare?

Table Of Materials

Is COVID-19 testing covered by Medicare?

Is COVID-19 treatment covered by Medicare?

Is COVID-19 vaccination and booster coverage covered by Medicare?

What Medicare does not cover

Medicare's components

As the COVID-19 pandemic continues, new medications and policies are being implemented in order to vaccinate, test, and treat as many people as possible.

Vaccines, treatment, and some COVID-19 tests are covered by Medicare for the 64 million Americans covered by Medicare and Medicare Advantage plans (including anyone on Medicare due to certain illnesses or receiving Social Security disability benefits), but the specifics can be difficult to determine.

Here's an overview of how Medicare covers COVID-19 testing, treatment, and vaccines.

Is COVID-19 Testing Covered By Medicare?

Laboratory examinations

Yes, Medicare Part B (medical insurance) covers all clinical laboratory test costs for COVID-19 detection and diagnosis, including copays, deductibles, and coinsurance. You don't need a doctor's order, and you're covered for tests performed by a laboratory, pharmacy, doctor, or hospital. A home health nurse, lab technician, or trained medical assistant may be able to administer a test to you at home in some cases.

This protection includes:

•Laboratory tests used to diagnose or assist in the diagnosis of COVID-19.

•Some tests for related respiratory conditions, performed in conjunction with a COVID-19 test, to aid in the diagnosis of COVID-19.

•Testing in a few parking lots.

If you've been diagnosed with COVID-19 or it's suspected that you've had COVID-19, Medicare Part B also covers FDA-approved COVID-19 antibody tests. These tests, also known as serology tests, can determine whether you have developed an immune response to COVID-19.

If you have a Medicare Advantage plan, it must also cover clinical laboratory tests to detect and diagnose COVID-19 without a copay, deductible, or coinsurance.

COVID at-home tests available over-the-counter

Yes. According to the Centers for Medicare & Medicaid Services, Medicare Part B and Medicare Advantage members will be able to get eight free at-home COVID-19 tests per month beginning April 4, 2022, from participating pharmacies and health care providers.

Those with Medicare Advantage plans typically receive this benefit through their Medicare Part B enrollment rather than directly from their plan. As a result, having your official Medicare card on hand when picking up COVID-19 testing kits may be beneficial.

If you only have Medicare Part A, the costs of over-the-counter COVID-19 tests are not covered. Other programs, however, provide free test kits.

Members are not required to submit an application for reimbursement for at-home tests. Medicare will pay pharmacies directly to provide the free tests.

Participation in the initiative to distribute free tests is entirely voluntary, so check with your pharmacy or health care provider to see if they are involved. A partial list of participating organizations, as well as links to location information, can be found at Medicare.gov/medicare-coronavirus.

The free test programme will continue until the COVID-19 public health emergency ends. The current status of the public health emergency can be found on the Department of Health and Human Services Public Health Emergency Declarations website.

Members of Medicare and Medicare Advantage can also get free at-home testing from other sources. The federal government offers sets of four free at-home COVID-19 tests to each household at covid.gov/tests. Free at-home tests may also be available from community health centers, clinics, and state and local governments.

Is COVID-19 Treatment Covered By Medicare?

Treatments with monoclonal antibodies

Yes, Medicare Part B covers monoclonal antibody treatments, which can help people with mild to moderate COVID-19 symptoms avoid hospitalization.

All medically necessary Medicare Part A and Part B services must be covered by Medicare Advantage plans. You are covered for medically necessary monoclonal antibody treatments if you have a Medicare Advantage plan.

COVID-19 hospitalisation

Yes, Medicare covers COVID-19-related hospitalization, including any days when you would have been discharged from inpatient care but had to stay in the hospital to quarantine. You will be responsible for any applicable hospital deductibles, copays, and coinsurance.

For example, if you have Original Medicare, you must pay a $1,556 Part A deductible in 2022 before coverage begins for the first 60 days of a hospital stay unless you have Medicare Supplement Insurance, or Medigap, which covers your deductible.

Your deductibles, copays, and coinsurance will vary depending on your Medicare Advantage plan.

COVID-19 Telehealth Services

Yes, during the COVID-19 pandemic, Medicare expanded coverage for telehealth services. You may be responsible for deductibles or coinsurance if you use telehealth services for COVID-19 care. In some cases, healthcare providers will reduce or waive your share of the costs.

Check to see if your Medicare Advantage plan includes additional telehealth services.

Is Covid-19 Vaccination And Booster Coverage Covered By Medicare?

Yes, Medicare covers all costs for COVID-19 vaccine shots, including booster shots. There is no deductible, copay, or admin fee. If you get your vaccine at a provider's office, they can't charge you for the visit unless you also received other health care services.

If you need an at-home vaccination, there is no charge for the vaccination or the administration of the shot.

Even if you're enrolled in a Medicare Advantage plan, keep your Medicare card or Medicare number on hand so the medical provider or pharmacy can bill Medicare. If you have Medicare Part B and must complete a form to obtain the vaccine, leave any "group number" fields blank or write "N/A."

Contact your state or local health department or visit its website to learn more about vaccines in your area. The Centers for Disease Control and Prevention's Vaccines.gov website can also assist you in locating a nearby location that provides the appropriate vaccine or booster for you.

What Medicare Does Not Cover

Medicare covers a wide range of services, but not everything. Learn about Medicare's position in the following areas:

•Dental.

•Amplification devices.

•Shingles vaccination.

•Cataract removal surgery.

•Eye examinations

•Chiropractic treatment.

•COVID testing and vaccines are available.

•Home health care services.

•Acupuncture.

•Hospice.

•Vaccinations against the flu

•Care in a nursing home.

•In-home care.

•Implants for the teeth.

•Services for mental health.

•Treatment for addiction.

•Ambulance services are available.

Medicare's Components

Learn more about the various components of Medicare and what they cover.

•Part A of Medicare (hospital insurance).

•Part B of Medicare (medical insurance).

•Part C of Medicare (Medicare Advantage).

•Part D of Medicare (prescription drug plan).

•Supplemental Medicare Insurance (Medigap).