Medicare Part B covers a variety of diagnostic tests, including testing for COVID-19.
Yes, Medicare does cover COVID testing. If you’re like most people, your life was probably been disrupted to some degree by the coronavirus (COVID-19) that reached pandemic levels in 2020, with national emergencies declared by governments all over the world. Thankfully, Medicare made it a priority to cover testing under almost any circumstances you can think of. We’ll run through all of the details, so you can know what to expect if you need to get tested.
What Types of Tests are Out There?
Novel Coronavirus, also known as COVID-19 or SARS-CoV-2, is a new virus in the coronavirus family. Testing is one of the most important ways to prevent the spread of this disease, because those who are infected don’t always show symptoms, and can pass it on to others unknowingly.
When talking about testing, two main types of tests are discussed, although there can also be methodological variations among these tests. The standard laboratory test is used to determine if one is currently infected with COVID-19, while the antibody test, also known as the serology test, is used to determine if you have been infected by it in the past.
COVID-19 Testing with Medicare Part B
Part B covers all outpatient services, and for most people, this includes testing from their healthcare provider. Testing may take place in a hospital setting, but we’ll go over that later. The majority of people who are tested will be tested in an outpatient context, such as their physician’s office or a dedicated outpatient testing site. In these situations, Medicare will fully cover your COVID-19 test.
Are There Out-of-Pocket Fees for Coronavirus Tests?
No, there are no out-of-pocket fees associated with testing under Part B. This goes for both the regular test and the antibody test. This means that even if your deductible hasn’t yet been reached, your test will still be fully covered. And, there is no cost-sharing, coinsurance, or copayment when you get your testing under Part B.
Part A: Testing in a Hospital Setting
Medicare Part A covers hospital and inpatient services. If you are admitted as an inpatient to a hospital, nursing home, skilled nursing facility, hospice, or other long-term care facility and are subsequently tested, your test will be covered by Part A. Similarly to Part B, your test will be fully covered: no additional out-of-pocket costs will apply specifically to the Coronavirus test.
However, normal Part A cost-sharing and deductible requirements will apply. You may have to pay out-of-pocket costs for your hospital admission, but not for your test specifically. You can learn more about your Part A out-of-pocket costs at medicare.gov.
One thing to note is that if you are tested in a hospital emergency room, your coverage may still come from Part B. You are only considered to be an inpatient if your emergency room visit results in hospitalization. This can cause some complications or confusion for people in certain situations, but it shouldn’t affect your Coronavirus test coverage in any way, since both Part A and Part B provide coverage.
What About Medicare Advantage?
Medicare Advantage health plans, also known as Part C plans, are a popular way of receiving your Medicare coverage through a private insurance plan. This contrasts from Original Medicare in many ways, but Medicare Advantage is still regulated to ensure that Medicare beneficiaries receive proper coverage.
When it comes to Coronavirus, Medicare Advantage plans are required to fully cover testing. This means that even if your plan doesn’t usually cover lab tests or antibody tests, it will have to cover the Coronavirus test.
Like Original Medicare, Medicare Advantage can’t charge any copays, coinsurance, or deductible fees for your Coronavirus test. This means that the coverage is effectively the same as Original Medicare: full coverage with no payment no matter where the test is done.
The one difference is that these regulations only apply for tests performed after February 4, 2020. If you got tested before that date and had to pay for your test, or had to pay a copayment or coinsurance, then there is no way to get around that fee. Thankfully, most tests were performed well after this date.
The COVID Vaccine
Medicare covers the COVID vaccine at 100%, meaning you'll pay nothing for this shot - or the booster (as of November 2021).
What About Other COVID Treatments?
If your test comes out positive, then your treatment will most likely begin immediately. Due to the novel nature of many COVID treatments, it can be hard to understand whether your treatment will be covered, even though the test is.
Although we can’t make statements about individual drugs or other specific therapies, Medicare will generally cover your COVID treatment. If you are hospitalized, then your Part A coverage will apply as usual. You will still be covered for your hospital stay even if you are asymptomatic and simply under quarantine.
If you are hospitalized for complications arising from Coronavirus, there are no specific regulations about your payment. This means that you will still have to pay your Part A deductible, coinsurance, and any other fees that apply.
The same is true for Part B. While your care will be covered, it will be covered in the same way that any other condition is covered. This means that you will still have to pay your deductible, coinsurance, and copayment for any treatment you receive under Part B.
What About Medicare Part D Prescription Drug Coverage?
If you need to receive any medications as part of your treatment, your coverage will vary depending on which Part D plan you have. Medications that are received as part of an inpatient or outpatient treatment, usually intravenously, will typically be covered by Part A or Part B respectively.
However, any medications you are prescribed as part of your treatment will have to be covered by your Part D plan or other private prescription drug plan for you to receive coverage. Because these plans vary, there’s no way to tell in advance what your plan will cover.
Key Takeaways: COVID and Medicare
Although COVID-19 has complicated the lives of many, Medicare beneficiaries can rest assured that almost all of their care and diagnostic testing will be covered. While treatment plans and payments will differ for everybody, testing will never be an issue.
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