Medicare covers COVID-19 tests performed in a laboratory, pharmacy, physician’s office, or hospital. It also applies to certain over-the-counter testing, with certain restrictions. There is no out-of-pocket expense for any COVID-19 vaccination authorized or approved by the FDA. Medicare also covers specific COVID-approved treatments.
What is covered by Medicare for COVID-19?
Medicare covers COVID-19 diagnostics and outpatient and inpatient therapies related to COVID-19 treatment. However, your out-of-pocket expenses for certain services and treatments may vary based on the length of your treatment and the type of Medicare coverage you have, either Original Medicare or a Medicare Advantage plan.
COVID-19 Items and Services Covered by Medicare
Vaccines approved or authorized by the FDA.
You incur no out-of-pocket costs for any COVID-19 vaccination authorized or approved by the Food and Drug Administration of the United States. This comprises all recommended doses of vaccinations manufactured by Pfizer-BioNTech, Moderna, or Johnson & Johnson (Jansen).
Laboratory tests for COV-19
A COVID-19 test performed in a laboratory, pharmacy, doctor’s office, or hospital is free. Tests ordered by a doctor or other approved health care practitioner are free.
Test for antibodies or serology
You incur no out-of-pocket expenses for a COVID-19 antibody test authorized or approved by the FDA. These can assess whether or not you have formed an immune response to the virus, indicating that you may not be at immediate risk for reinfection.
Monoclonal antibody therapy
During the COVID-19 Public Health Emergency, Medicare will cover the total cost of monoclonal antibody treatments, including sotrovimab and bebtelovimab. You must test positive for COVID-19, have a mild to moderate case, and be at high risk of developing a severe case or needing hospitalization.
All hospitalizations essential for medical treatment
Medicare will reimburse its portion of hospitalization costs if you are hospitalized due to COVID-19 or if you were hospitalized for another reason and forced to remain beyond release due to quarantine. You are still liable for all applicable hospital deductibles, copayments, and coinsurance.
How Do Medicare Advantage Plans Differ Regarding Coverage for COVID-19?
Medicare Advantage plans may cover COVID-19 testing and services differently from Original Medicare.
Medicare Advantage programs should cover original Medicare. However, many Medicare Advantage plans offer telemedicine services and other benefits that Original Medicare may not.
Does Medicare Advantage Cover Testing for COVID-19?
Medicare Advantage fully covers numerous COVID-19 tests, therapies, and other costs. This policy covers 100 percent of Medicare-approved COVID-19 diagnostic testing performed by a laboratory, pharmacy, or doctor’s office. For most COVID-19-related testing, neither the Part B deductible nor coinsurance will apply.
Medicare Advantage plans may also waive costs for COVID-19 laboratory tests.
Medicare has a new initiative covering up to eight COVID-19 tests purchased over the counter each month at no cost.
Who qualifies?
If you have Part B, including those enrolled in a Medicare Advantage plan, Medicare will fund these testing.
Suppose you are enrolled in a Medicare Advantage plan. In that case, the tests covered under this initiative will be covered in addition to any over-the-counter tests that may be covered as a supplemental benefit under your plan.
If you just have Medicare Part A (Hospital Insurance), Medicare will not fund over-the-counter COVID-19 tests, but you may be eligible for free tests through other programs.
If you test positive, you can receive medical care before the virus progresses.
Healthcare providers can also track down everybody you’ve come into contact with and inform them of the potential danger of infection, allowing them to self-isolate or enter quarantine to prevent the spread of the disease.
Tests for Diagnosis or Exclusion of COVID-19
COVID-19 testing is covered by Medicare Part B medical insurance.
Medicare will cover the full cost of any lab, pharmacy, physician, or hospital tests to diagnose or rule out COVID-19. No out-of-pocket expenses will be your responsibility.
Diagnostic Tests for COVID-19
PCR test
PCR tests, also known as molecular testing, take genetic material from a nasal swab, throat swab, or saliva swab to identify the virus. Some tests can take a few days to return results, and other rapid test versions can provide results within a few minutes. The sensitivity of PCR testing is extremely high, although the fast version can miss some positive instances.
Antigen test
Antigen tests offer results in minutes using a nasal or throat swab to detect proteins in the virus. With antigen tests, positive test findings are highly accurate, but there is a greater potential of false negatives, meaning you may have the virus, but the test misses it. Due to this possibility, if you test negative with an antigen test, your physician will frequently request a PCR test to confirm that you are not infected.
Your physician, pharmacist, laboratory technician, home health nurse, or another appropriately educated medical practitioner or assistant may conduct diagnostic testing.
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