Patients who get seriously ill from the virus may need a variety of inpatient and outpatient services. Does Medicare cover treatment for COVID-19? 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. A testing-related service is a medical visit furnished during the emergency period that results in ordering or administering the test. (Under traditional Medicare, beneficiaries typically face a $233 deductible for Part B services and coinsurance of 20 percent.)Ī 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). Beneficiaries will also not face cost sharing for the COVID-19 serology test, since it is considered to be a diagnostic laboratory test. Medicare beneficiaries who get a lab test 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. According to other actions announced by the Biden Administration in December 2021, beneficiaries can also access free at-home tests through neighborhood sites such as health centers and rural clinics and can request four free at-home tests through a federal government website. Under the Biden Administration’s initiative for Medicare to cover the cost of up to 8 at-home COVID tests per month for Medicare beneficiaries with Part B, Medicare beneficiaries can get the tests at no cost through eligible pharmacies and other entities during the COVID-19 public health emergency. How much do Medicare beneficiaries pay for COVID-19 testing? Medicare Advantage plans are required to cover all Medicare Part A and Part B services, including lab tests for COVID-19. Medicare also covers serology tests (antibody tests), that can determine whether an individual has been infected with SARS-CoV-2, the virus that causes COVID-19, and developed antibodies to the virus. Under revised rules finalized on September 2, 2020, a beneficiary may receive Medicare coverage for one COVID-19 and related test without the order of a physician or other health practitioner, but then must receive a physician order for any further COVID-19 testing. Medicare covers medically necessary clinical diagnostic laboratory tests when a doctor or other health practitioner orders them. Medicare covers diagnostic lab testing for COVID-19 under Part B. Medicare Advantage plans can also opt to cover the cost of at-home tests, but this is not required. Under this new initiative, Medicare beneficiaries can get the tests at no cost from eligible pharmacies and other entities they do not need to pay for the tests and submit for reimbursement. In April 2022, the Biden Administration finalized an initiative providing for Medicare coverage of up to 8 at-home COVID tests per month for Medicare beneficiaries with Part B, including beneficiaries in traditional Medicare and Medicare Advantage. Does Medicare cover testing for COVID-19? These FAQs review current policies for Medicare coverage and costs associated with testing and treatment for COVID-19, including regulatory changes issued by CMS since the declaration of the public health emergency ( first issued on Januand most recently renewed in January 2022), and legislative changes in three bills enacted since the start of the pandemic: the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, enacted on Ma(Public Law 116-123) the Families First Coronavirus Response Act, enacted on Ma(Public Law 116-127) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted on Ma(Public Law 116-136). According to data from the Centers for Medicare & Medicaid Services (CMS), through November 20, 2021, there have been over 6 million cases of COVID-19 among Medicare beneficiaries and 1.6 million hospitalizations. Diagnosis of COVID-19 is confirmed through testing, and treatment varies based on the severity of illness. COVID-19 is an infectious disease which currently has no cure, although several therapeutics and vaccines have been or are being developed. 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 SARS-CoV-2, the coronavirus that causes COVID-19. More than 60 million people ages 65 and older and younger adults with long-term disabilities are covered by Medicare.
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