Medicare and Coronavirus: What You Need to Know
Posted on April 2, 2020 by Seema Verma, Administrator of the Centers for Medicare and Medicaid Services
With the spread of coronavirus (COVID-19), being informed about your Medicare coverage is more important than ever.
Medicare recently expanded its coverage of telehealth services. Telehealth enables beneficiaries to receive a wider range of healthcare services from doctors without having to travel to a healthcare facility. It also helps frontline clinicians stay safe themselves while treating people.
If your doctor orders a COVID-19 test for you, Medicare covers all of the costs. You should not have any co-pay, no matter what Medicare plan you’re enrolled in. There’s no vaccine for COVID-19 at this time, but when one becomes available, Medicare will cover it.
Medicare also covers all medically necessary hospitalizations. This includes extra days in the hospital for in-patients who were on the verge of being discharged, but were diagnosed with COVID-19 and had to stay longer under quarantine.
Doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers can deliver telehealth services. Medicare beneficiaries can receive telehealth services in their home, as well as in any healthcare facility, a physician’s office, hospital, nursing home, or rural health clinic.
Telehealth services can include routine office visits, mental health counseling, and preventive health screenings for cancer and other illnesses.
By helping healthcare institutions across the nation offer medical services remotely, telehealth helps free up hospital emergency departments and doctors’ offices to deal with the most urgent COVID-19 cases.
During this emergency, Medicare will pay for telehealth services at the same rates as in-person services, giving doctors and other medical professionals the opportunity to reserve their offices to treat those who truly require in-person care.
We know many Medicare beneficiaries are concerned about the spread of coronavirus and the threat it poses to their well-being. That’s why we’ve taken these rapid steps to ensure that the Medicare program continues to protect our beneficiaries while maintaining trusted access to care in these uncertain times.
FAQs on Medicare Coverage and Costs Related to COVID-19 Testing and Treatment
Juliette Cubanski and Meredith Freed for Kaiser Family Foundation
Published: Mar 30, 2020
More than 60 million people ages 65 and older and younger adults with long-term disabilities are covered by Medicare. Due to their older age and higher likelihood of having serious medical conditions than younger adults, virtually all Medicare beneficiaries are at greater risk of becoming seriously ill if they are infected with the new coronavirus that causes COVID-19. COVID-19 is an infectious respiratory disease, which currently has no vaccine or cure. Diagnosis of COVID-19 is confirmed through testing, and treatment varies based on the severity of illness.
These FAQs review current policies for Medicare coverage and costs associated with testing and treatment for COVID-19, including changes adopted in three recent bills: the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, enacted on March 6, 2020 (Public Law 116-123); the Families First Coronavirus Response Act, enacted on March 18, 2020 (Public Law 116-127); and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted on March 27, 2020 (Public Law 116-136).
Does Medicare cover testing for COVID-19?
Yes, testing for COVID-19 is covered under Medicare Part B when it is ordered by a doctor or another health care provider that accepts Medicare, and if the test was ordered after February 4, 2020. Medicare Advantage plans are required to cover all Medicare Part A and Part B services, including COVID-19 testing.
How much do Medicare beneficiaries pay for COVID-19 testing?
Medicare beneficiaries who get tested for COVID-19 are not required to pay the Part B deductible or any coinsurance for this test, because clinical diagnostic laboratory tests are covered under traditional Medicare at no cost sharing. (Under traditional Medicare, beneficiaries typically face a $198 deductible for Part B services and coinsurance of 20 percent.) 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 visit (such as hospital observation, E-visit, or emergency department services). A testing-related service is a medical visit furnished during the emergency period that results in ordering or administering the test. The law also eliminates cost sharing for Medicare Advantage enrollees for both the COVID-19 test and testing-related services, and prohibits the use of prior authorization or other utilization management requirements for these services.
Does Medicare cover treatment for COVID-19?
Currently there is no known treatment for COVID-19 beyond treating the symptoms of the disease. Patients who get seriously ill from the virus may need a variety of inpatient and outpatient services. Medicare covers inpatient hospital stays, skilled nursing facility (SNF) stays, some home health visits, and hospice care under Part A, and outpatient services, including physician visits, emergency ambulance transportation, and emergency room visits, under Part B. If an inpatient hospitalization is required for treatment of COVID-19, this treatment will be covered for Medicare beneficiaries, including beneficiaries in traditional Medicare and those in Medicare Advantage plans. Beneficiaries who need post-acute care following a hospitalization have coverage of SNF stays, but Medicare does not cover long-term services and supports, such as extended stays in a nursing home.
How much do Medicare beneficiaries pay for COVID-19 treatment?
Beneficiaries who are admitted to a hospital for treatment would be subject to the Medicare Part A deductible of $1,408 per benefit period in 2020. Part A also requires daily copayments for extended inpatient hospital and SNF stays. For extended hospital stays, beneficiaries would pay a $352 copayment per day (days 61-90) and $704 per day for lifetime reserve days. If a patient is required to be quarantined in the hospital, even if they no longer meet the need for acute inpatient care and would otherwise by discharged, they would not be required to pay an additional deductible for quarantine in a hospital. Traditional Medicare beneficiaries who need post-acute care following a hospitalization would face copayments of $176 per day for extended days in a SNF (days 21-100). For COVID-19 treatment-related outpatient services covered under Part B, there is a $198 deductible in 2020 and 20 percent coinsurance that applies to most services, including physician visits and emergency ambulance transportation.
While most traditional Medicare beneficiaries (81% in 2016) have supplemental coverage (such as Medigap, retiree health benefits, or Medicaid) that covers some or all of their cost-sharing requirements, more than 6 million beneficiaries lacked supplemental coverage in 2016, which places them at greater risk of incurring high medical expenses or foregoing medical care due to costs. Medicare does not have an out-of-pocket limit for services covered under Medicare Parts A and B.
Cost-sharing requirements for beneficiaries in Medicare Advantage plans vary across plans. Medicare Advantage plans often charge daily copayments for inpatient hospital stays, emergency room services, and ambulance transportation. Medicare Advantage enrollees can be expected to face varying costs for a hospital stay depending on the length of stay and their plan’s cost-sharing amounts. According to CMS guidance, Medicare Advantage plans may waive or reduce cost sharing for COVID-19-related treatments, and some companies have announced that they plan to do so, but this is not required. Plans may also waive prior authorization requirements that would apply to services related to COVID-19.
If a vaccine is approved for COVID-19, would it be covered by Medicare?
Medicare Part B covers certain preventive vaccines (influenza, pneumococcal, and Hepatitis B), and these vaccines are not subject to Part B coinsurance and the deductible. Medicare Part B also covers vaccines related to medically necessary treatment. For traditional Medicare beneficiaries who need these medically necessary vaccines, the Part B deductible and 20 percent coinsurance would apply. Based on a provision in the CARES Act, if a vaccine becomes available for COVID-19, Medicare is required to cover this vaccine under Part B with no cost sharing for Medicare beneficiaries for the vaccine or its administration; this applies to beneficiaries in both traditional Medicare and Medicare Advantage plans.
What telehealth benefits are covered by Medicare, and how much do beneficiaries pay?
Based on new waiver authority included in the Coronavirus Preparedness and Response Supplemental Appropriations Act (and as amended by the CARES Act) the HHS Secretary has waived certain restrictions on Medicare coverage of telehealth services for traditional Medicare beneficiaries during the coronavirus public health emergency. The waiver, effective for services starting on March 6, 2020, allows beneficiaries in any geographic area to receive telehealth services; allows beneficiaries to remain in their homes for telehealth visits reimbursed by Medicare; allows telehealth visits to be delivered via smartphone with real-time audio/video interactive capabilities in lieu of other equipment; and removes the requirement that providers of telehealth services have treated the beneficiary receiving these services in the last three years. A separate provision in the CARES Act allows federally qualified health centers and rural health clinics to provide telehealth services to Medicare beneficiaries during the COVID-19 emergency period. Telehealth services are not limited to COVID-19 related services, and can include regular office visits, mental health counseling, and preventive health screenings.
Traditional Medicare also covers brief, “virtual check-ins” via telephone or captured video image, and E-visits, for all beneficiaries, regardless of whether they reside in a rural area. These visits are more limited in scope than a full telehealth visit, and there is no originating site requirement. Medicare covers all types of telehealth services under Part B, so beneficiaries in traditional Medicare who use these benefits are subject to the Part B deductible of $198 in 2020 and 20 percent coinsurance. However, the HHS Office of Inspector General is providing flexibility for providers to reduce or waive cost sharing for telehealth visits during the COVID-19 public health emergency.
Medicare Advantage plans are able to offer additional telehealth benefits not covered by traditional Medicare, including telehealth visits for beneficiaries provided to enrollees in their own homes, and services provided outside of rural areas. Medicare Advantage plans have flexibility to waive certain requirements with regard to coverage and cost sharing in cases of disaster or emergency, such as the COVID-19 outbreak. In response to the coronavirus pandemic, CMS has advised plans that they may waive or reduce cost sharing for telehealth services, as long as plans do this uniformly for all similarly situated enrollees.
Can Medicare beneficiaries get extended supplies of medication?
The Department of Homeland Security recommends that, in advance of a pandemic, people ensure they have a continuous supply of regular prescription drugs. In light of the coronavirus pandemic, a provision in the CARES Act requires Part D plans (both stand-alone drug plans and Medicare Advantage drug plans) to provide up to a 90-day (3 month) supply of covered Part D drugs to enrollees who request it. (Typically Medicare Part D plans place limits on the amount of medication people can receive at one time and the frequency with which patients can refill their medications.)
According to CMS, for drugs covered under Part B, Medicare and its contractors make decisions locally and on a case-by-case basis as to whether to provide and pay for a greater-than-30 day supply of drugs.
What happens if Medicare beneficiaries in private plans need to receive care from out-of-network providers?
Plans that provide Medicare-covered benefits to Medicare beneficiaries, including stand-alone prescription drug plans and Medicare Advantage plans, typically have provider networks and limit the ability of enrollees to receive Medicare-covered services from out-of-network providers, or charge enrollees more when they receive services from out-of-network providers or pharmacies. In light of the declaration of a public health emergency in response to the coronavirus pandemic, certain special requirements with regard to out-of-network services are in place. During the period of the declared emergency, Medicare Advantage plans are required to cover services at out-of-network facilities that participate in Medicare, and charge enrollees who are affected by the emergency and who receive care at out-of-network facilities no more than they would face if they had received care at an in-network facility.
Part D plan sponsors are also required to ensure that their enrollees have adequate access to covered Part D drugs at out-of-network pharmacies when enrollees cannot reasonably be expected to use in-network pharmacies. Part D plans may also relax restrictions they may have in place with regard to various methods of delivery, such as mail or home delivery, to ensure access to needed medications for enrollees who may be unable to get to a retail pharmacy.
Are there any special rules for Medicare coverage for skilled nursing facility or nursing home residents related to COVID-19?
In response to the national emergency declaration related to the coronavirus pandemic, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) for those Medicare beneficiaries who need to be transferred as a result of the effect of a disaster or emergency. For beneficiaries who may have recently exhausted their SNF benefits, the waiver from CMS authorizes renewed 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 disease, are entitled to those benefits in the same manner that community residents with Medicare are.
Medicare establishes quality and safety standards for nursing facilities with Medicare beds, and has issued guidance related to infection control and prevention for COVID-19 to limit the exposure of nursing home staff and patients. This guidance directs nursing homes to restrict visitation by all visitors and non-essential health care personnel (except in compassionate care situations such as end-of-life), cancel communal dining and other group activities, and actively screen residents and staff for symptoms of COVID-19. These new rules do not apply to assisted living facilities, which are regulated by states.
How insurers are covering COVID-19
Insurers are weighing how best to respond to the outbreak of the novel coronavirus as cases swell in the U.S. Here is a tracker to follow the latest policy and coverage decisions from the nation’s largest insurers.
Updated April 3, 2020 • By Samantha Liss for Healthcaredrive
Latest coverage decisions for the nation’s largest insurers.
Blue Cross Blue Shield Association
The BCBSA is eliminating cost-sharing for COVID-19 diagnostic testing. It will also waive cost-sharing for treatment at in-network or Medciare rates through May 31, including inpatient stays.
BCBSA will remove prior authorization requirements for testing and for services that are medically necessary to treat an infected patient. BCBSA also is waiving limits on early refills to make it easier to access medications and expanding access to telehealth services.
Molina is halting cost-sharing for testing and treatment. That policy applies to Medicare, Medicaid and marketplace members nationwide.
Aetna will waive cost-sharing for certain members admitted to an in-network hospital with COVID-19 or complications from the disease. The policy applies to all of Aetna’s commercial plans, though self-insured members can opt out. The policy will apply to admissions through June 1. Aetna also is waiving cost-sharing for testing and associated visits, including telehealth.
Aetna also is attempting to make access to hospitalization faster for those with COVID-19 by easing prior authorization requirements, particularly in areas hard hit by the outbreak like New York and Washington.
The nation’s second largest commercial insurer will waive cost-sharing for COVID-19 treatment and will reimburse providers at either in-network or Medicare rates through May 31. The policy applies to Anthem’s fully insured, individual, Medicaid and Medicare Advantage members. Self-insured plans can opt out. Anthem also is waiving cost-sharing for COVID-19 testing and in-network visits associated with testing whether it’s conducted at a physician’s office, urgent care or ER.
Anthem also is easing its limits on early refills for 30-day prescriptions. Anthem said it would waive cost sharing for telehealth visits, including those for mental health for a period of 90 days starting March 17. Self-insured plans have the option to opt in the new virtual care policy.
Centene will waive cost-sharing for COVID-19 related screening, testing and treatment for its Medicaid, Medicare and Marketplace members through June 30.
Centene also will eliminate prior authorization requirements for care for all its Medicare, Medicaid and Marketplace members. The company is also working to supply federally qualified health centers with personal protective equipment and assistance in providing small business loans to behavioral health providers and long-term service support organizations.
Cigna will waive cost-sharing for all COVID-19 treatment, including testing and telehealth screenings through May 31. The policy applies to Cigna’s fully-insured group plans, individual coverage and Medicare Advantage plans. Self-insured plans can opt out.
Cigna will reimburse providers either at in-network or Medicare rates depending on the member. Cigna also is easing access to maintenance medication by offering free shipping for a 90-day supply. Cigna is easing prior authorization requirements for patients being discharged from the hospital to post-acure stays.
Humana is waiving cost-sharing for testing and treatment, including hospital admissions for COVID-19 cases. The policy applies to its Medicare Advantage plans, fully-insured commercial plans, Medicare supplement and its Medicaid plans. The policy is indefinite with no current end date. Cost-sharing will be waived for all telehealth visits and members can opt to refill prescriptions early.
Humana also is easing administrative barriers to allow infected patients to easily move from a hospital to post-acute care settings. It’s suspending prior authorization and referral requirements and requesting notification within 24 hours. It’s also implementing an expedited claims process to reimburse providers faster, Humana said.
The nation’s largest commercial insurer, will waive cost-sharing for COVID-19 treatment through May 31. The policy applies to its fully-insured commercial, Medicare Advantage and Medicaid plans. United also is waiving cost-sharing for COVID-19 testing at approved locations in accordance with Centers for Disease Control guidelines. There will be no cost-sharing for visits related to testing including at physician offices, urgent care, ERs and telehealth visits. The policy applies to United’s commercial, Medicare Advantage and Medicaid members.
UnitedHealthcare is opening a special enrollment period for some of its commercial members who opted out of coverage during the traditional enrollment period with their employers. This enrollment period will end April 6. The insurer also is easing prior authorization requirements through May 31, suspending prior approval for post-acute care and switching to a new provider.
Marketplace coverage & Coronavirus
If you already have coverage through the Marketplace, the rules in your Marketplace health plan for treatment for the coronavirus emergency (officially called 2019 Novel Coronavirus or COVID-19) remain the same as any other viral infection.
See what Marketplace plans cover.
You can also check with your health insurance company for their specific benefits and coverage policy.
All Marketplace plans cover treatment for pre-existing medical conditions and can’t terminate coverage due to a change in health status, including diagnosis or treatment of COVID-19. While your coverage benefits will remain the same, you should log in to update your Marketplace application if COVID-19 impacts your income or household. You may be able to change your plan if certain situations apply.
If I lost my job or experienced a reduction in hours due to COVID-19
If you lost your job-based health plan: You may qualify for a Special Enrollment Period if you lost health coverage through your employer or the employer of a family member in the past 60 days OR you expect to lose coverage in the next 60 days, including if you lose health coverage through a parent or guardian because you’re no longer a dependent.
Note: Losing coverage you have as a dependent doesn’t qualify you for a Special Enrollment Period if you voluntarily drop the coverage. You also don’t qualify if you or your family member loses coverage because you don’t pay your premium.
If your employer reduced the hours you work and you’re enrolled in a Marketplace plan: Update your application immediately within 30 days to report any household income changes. You may qualify for more savings than you’re getting now.
If you were furloughed: In some situations depending on the status of your health coverage from your employer, you may qualify for a Special Enrollment Period. You may be eligible for a premium tax credit to help pay for Marketplace coverage too. Create an account or log in to start your Marketplace application to find out if you qualify.
If you have COBRA continuation coverage:
If you’re entitled to COBRA continuation coverage after you lost your job-based coverage, you may still qualify for a Special Enrollment Period due to loss of coverage. You have 60 days after your loss of pre-COBRA job-based coverage to enroll in Marketplace coverage. You may also qualify for premium tax credits if you end your COBRA continuation coverage.
If you’re enrolled in COBRA continuation coverage, you may qualify for a Special Enrollment Period if your COBRA continuation coverage costs change because your former employer stopped contributing, so you have to pay full cost.
Learn more about COBRA continuation coverage and the Marketplace.
If you lost your job, but didn’t also lose health coverage, because your former job didn’t offer coverage: You generally won’t qualify for a Special Enrollment Period. By itself, a job loss (or a change in income) doesn’t make you eligible for a Special Enrollment Period to enroll in Marketplace coverage. See if you qualify for a Special Enrollment Period another way.
Coverage start dates with a Special Enrollment Period due to loss in coverage
If you’ve already lost coverage, your Marketplace coverage can start the first of the month after you apply and enroll.
If you know you’ll lose coverage within the next 60 days, you can submit an application on HealthCare.gov before you actually lose your coverage to help make sure there’s no gap in coverage. For example, if you know you’ll lose coverage on April 30, and apply and enroll in a Marketplace plan April 10, your new coverage will start May 1.
If I can’t pay my premiums because of a hardship due to COVID-19
- Check with your insurance company about extending your premium payment deadline or ask if they will delay terminating your coverage if you can’t pay your premiums.
- Most of the time, if you aren’t receiving financial assistance with your premiums, you have a grace period determined by state law (often one month). If you’re getting financial assistance, you have a three-month grace period during which your coverage can’t be terminated for not paying your premiums.
- If your household income has changed, update your application immediately. You could qualify for more savings than you’re getting now.
If I’m enrolled in a Marketplace plan and my income has changed
- If you’re enrolled in a Marketplace plan and your household income has changed, update your application immediately. If your income goes down or you gain a household member:
- You could qualify for more savings than you’re getting now. This could lower what you pay in monthly premiums.
- You could qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
If I previously qualified for a Special Enrollment Period, but missed the deadline because I was impacted by the COVID-19 national emergency
If you qualified for a Special Enrollment Period but missed the deadline due to COVID-19 (like if you were sick with COVID-19 or were caring for someone who was sick with COVID-19), you may be eligible for another Special Enrollment Period. Visit FEMA.gov for information about emergencies in your state.
To see if you’re eligible for this Special Enrollment Period, contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325).
If I want to change my current Marketplace plan or enroll for the first time
If you’ve had qualifying life changes, like if you move, have a baby, or lose other health coverage, you may be able to enroll in Marketplace coverage for the first time or change your current plan through a Special Enrollment Period.
Answer a few questions to find out if you can enroll in or change your coverage.
Q: If my child is now living with me after their college sent them home early
A: Your child can generally qualify for a Special Enrollment Period due to change in residence if they’re:
- Still enrolled in a student health plan that counts as qualifying health coverage, but the coverage and benefits don’t extend to your area.
- Had qualifying health coverage or lived in a foreign country or a U.S. territory for at least one of the 60 days before the date of their move. Note: This requirement doesn’t apply to members of a federally recognized tribe or Shareholders of Alaska Native Corporations.
If your child is under 26 and you’re already enrolled in Marketplace coverage, you may be able to add your child to your plan.
- If you have Marketplace coverage with savings and don’t plan to claim your child as a tax dependent on your federal tax return, your child should set up their own Marketplace account and submit a separate application.
- If you plan to claim your child as a tax dependent on your federal tax return, and you currently have Marketplace savings with your coverage, you can update your Marketplace application and add your child.
- If you have Marketplace coverage without requesting savings, you can put everyone on one application.
If I get a direct deposit or check from the IRS that is called an economic impact payment
The Coronavirus Aid, Relief, and Economic Security (CARES) Act calls for the IRS to make economic impact payments of up to $1,200 per taxpayer and $500 for each qualifying child. If you get one of these payments, you don’t need to include it in the income you report on your HealthCare.gov application. These payments don’t impact your eligibility for financial assistance for health care coverage through the Marketplace, or your eligibility for Medicaid or the Children’s Health Insurance Program (CHIP). For more information, visit IRS Coronavirus Tax Relief information.