Does Medicare Cover COVID-19 Testing and Services?
Medicare covers COVID-19 tests whether done by a lab, pharmacy, doctor or hospital. It also covers over-the-counter tests with some restrictions. There is no out-of-pocket cost for any FDA-approved or authorized COVID-19 vaccine. Medicare also covers certain approved COVID treatments.
What Does Medicare Cover for COVID-19?
COVID-19 tests, along with outpatient and inpatient services related to COVID-19 treatment, are covered by Medicare. But your out-of-pocket costs for some services and treatments can vary depending on the length of your treatment and the type of Medicare coverage you have — Original Medicare or a Medicare Advantage plan.
- FDA-approved or FDA-authorized vaccines
- You pay no out-of-pocket expenses for any COVID-19 vaccine approved or authorized by the U.S. Food and Drug Administration. This includes all recommended doses of the Pfizer-BioNTech, Moderna or Johnson & Johnson (Jansen) vaccines.
- Lab tests for COVID-19
- You pay nothing for a COVID-19 test performed at a laboratory, pharmacy, doctor’s office or hospital. You also pay nothing if a doctor or other authorized health care provider orders a test.
- Antibody or serology test
- You pay nothing out-of-pocket for an FDA-authorized or approved COVID-19 antibody test. These can determine if you developed an immune response to the virus and may not be at immediate risk of reinfection.
- Monoclonal antibody treatments
- Medicare will pay the full cost of monoclonal antibody treatments, such as sotrovimab or bebtelovimab, during the COVID-19 Public Health Emergency. But you must get the treatment from a Medicare provider or supplier and meet certain conditions — you must test positive for COVID-19, have a mild to moderate case, and you are at a high risk of progressing to a severe case or at a high risk of requiring hospitalization.
- All medically necessary hospitalizations
- If you have to be hospitalized because of COVID-19, or if you were in the hospital for some other reason and required to remain after discharge due to quarantine, Medicare will pay its share of hospitalization costs. You are still responsible for any hospital deductibles, copays and coinsurance that apply.
How Do Medicare Advantage Plans Differ for COVID-19 Coverage?
Coverage for COVID-19 testing and services under Medicare Advantage plans may differ from Original Medicare.
Medicare Advantage plans should cover the same services as Original Medicare. But many Medicare Advantage plans offer additional telehealth and other expanded benefits that Original Medicare may not offer.
Does Medicare Advantage Cover COVID-19 Testing?
Medicare Advantage covers the full cost of many COVID-19 tests, treatments and other expenses. This coverage includes 100% of Medicare-approved diagnostic COVID-19 testing services performed by a laboratory, pharmacy or doctor’s office. For most of your COVID-19 related testing, there will be no Part B deductible or coinsurance.
Medicare Advantage plans are also allowed to waive cost-sharing for COVID-19 lab tests.
- Costco Pharmacy
- Food Lion
- Rite Aid
- The Giant Company
There are other options to receive at-home tests.
Every household in the U.S. can order four at-home rapid COVID-19 tests to their home for free. According to NBC News, if you already ordered your first batch of rapid tests back in January, you’re now eligible to order four more free COVID-19 tests.
You should check with your plan’s provider to find out exactly what benefits you are eligible for under your Medicare Advantage plan.
As of April 4, all beneficiaries will have access to the eight over-the-counter (OTC) COVID-19 tests, in addition to the supplemental benefits that are included in their Medicare Advantage plan.
Each Medicare Advantage plan has different OTC supplemental coverage. For example, UnitedHealthcare plans cover up to $40 of OTC products per quarter. This means three COVID-19 tests would be covered every three months under certain UnitedHealthcare plans.
According to Kaiser Family Foundation, 79% of enrollees in Medicare Advantage plans and 97% of enrollees in Medicare Advantage Special Needs Plans (SNPs) were enrolled in a plan with OTC benefits in 2021.
Each plan varies, so check your OTC supplement benefits before ordering your OTC COVID-19 tests.
Does Medicare Cover At-Home COVID-19 Tests?
Beginning in Spring 2022, people with Original Medicare will be able to get up to eight free, over-the-counter COVID-19 tests per month. You will have to go to a pharmacy that is participating in the Medicare project.
Some Medicare Advantage plans may pay for over-the-counter, at-home COVID-19 tests. Check with your plan’s administrator to see if your plan covers the tests.
You can also find low-to-no-cost COVID-19 tests through more than 20,000 free community-based testing sites across the United States. The U.S. Department of Health and Human Services has an online testing site locator tool to help you find a site near you.
Medicare Coverage of COVID-19 Lab Tests
Medicare covers the costs of lab tests to see if you currently have COVID-19 as well as FDA-authorized antibody – or serology – tests that can determine if you had COVID-19 in the past. If you have Medicare, you will have no out-of-pocket costs for these tests.
If you test positive, you can get medical attention sooner, before the virus advances.
Health care professionals can also trace any people you’ve encountered and warn them of the risk of potential infection, allowing them to self-isolate or go into quarantine so they don’t spread the disease to other people.
Tests to Diagnose or Rule Out COVID-19
Medicare Part B medical insurance covers tests to determine if you have COVID-19.
If you undergo any tests to either diagnose or rule out COVID-19 — whether done by a lab, pharmacy, doctor or hospital — Medicare will cover the full cost. You will not be responsible for any out-of-pocket costs.
- PCR test
- Also called a molecular test, PCR tests collect genetic material that can identify the virus with a swab of the nasal passage, the throat or saliva. Results can take a few days with some tests, but rapid test versions can return results in a few minutes. PCR tests are very accurate, but the rapid version can miss some positive cases.
- Antigen test
- Antigen tests look for proteins in the virus using a nasal or throat swab to deliver results in minutes. Positive test results are very accurate with antigen tests, but there is an increased chance of returning false-negatives — meaning you may have the virus and the test misses it. Because of this chance, if you test negative with an antigen test, your doctor will often order a PCR test to make sure you’re not infected.
Diagnostic tests may be done by your doctor or pharmacist, a laboratory technician, home health nurse or other properly trained health professional or assistant.
Antibody Tests for COVID-19
Medicare Part B medical insurance covers the costs of antibody tests approved by the U.S. Food and Drug Administration. You pay nothing for these tests.
Antibody tests — also called serology tests — can sometimes determine if you previously had COVID-19. They work by testing whether you have developed an immune response to COVID-19 and therefore may not be at immediate risk of COVID-19 reinfection.
If the test shows that your body has antibodies against COVID-19, this indicates that you had the virus at some point in the past. Timing plays an important role in the accuracy of antibody tests.
These tests are usually done after full recovery from COVID-19. Antibody tests are not recommended until 14 days after you first experience symptoms.
It’s still not clear to what extent or for how long antibodies will protect you from reinfection. It’s important to keep up social distancing, mask use and other public health precautions even if you test positive for COVID-19 antibodies.
What COVID-19 Treatment and Services Does Medicare Cover?
If you have COVID-19, Original Medicare and Medicare Advantage plans cover several inpatient and outpatient treatments and health care services.
The U.S. Centers for Medicare and Medicaid Services also announced in Nov. 2020 that it was “taking action to increase reimbursement for any new COVID treatments that are approved by the FDA.”
- Certain home health care visits
- Doctor visits
- Emergency ambulance transportation
- Emergency room visits
- Hospice care
- Hospital stays
- Outpatient services
- Skilled nursing facility stays
- FDA-approved or authorized COVID-19 vaccines
- FDA-approved treatments
Under Original Medicare, Medicare Part A covers services related to inpatient hospital, hospice and skilled nursing facility care. Medicare Part B covers outpatient services, including doctor visits. Medicare Advantage plans are required to cover the same services as Original Medicare.
Does Medicare Advantage Cover COVID-19 Treatment?
Medicare Advantage covers monoclonal antibody treatments if they’re deemed medically necessary. Monoclonal antibody treatments have been proven to reduce COVID-19 hospitalization rates and slow down infection. You can also get up to one COVID-19 lab-performed test, without an order and at no cost.
- You tested positive for COVID-19.
- You have a mild-to-moderate case of COVID-19.
- You’re at high risk of progressing to a severe case of COVID-19 and/or at high risk of requiring hospitalization.
For monoclonal antibody treatment to be effective, the treatment must be given within seven days of the start of your symptoms.
If you don’t qualify for monoclonal antibody treatment, or it isn’t the treatment you’re looking for, there are other options available.
- Lab diagnostic testing
- Antibody tests
- Telehealth services
Additional and Expanded Medicare Services
Since COVID-19 became a global pandemic in 2020, Medicare has moved to cover additional services, expand access to telehealth and waive restrictions. Many of these moves are only temporary until the national emergency passes.
- Allowed Medicare Advantage and Medicare Part D plans to waive or relax prior authorization rules for prescriptions.
- Cleared hospitals to offer services such as off-site screenings in other facilities.
- Waived certain requirements for skilled nursing facilities.
- Instructed nursing homes and hospitals to review their infection control procedures.
- Expanded telehealth services, roughly doubling the services available.
How Much Do You Have to Pay Out-of-Pocket for COVID-19 Care?
If you are on Medicare and require health care because of COVID-19, you may have to pay out-of-pocket expenses. These expenses include deductibles, copayments and coinsurance.
Under Medicare Part A hospital insurance, the $1,556 deductible in 2022 still applies. You will also have to pay daily copayments for hospital stays longer than 60 days. This includes a $389 per day copayment from day 61 through day 90 and $778 per day for lifetime reserve days beyond that. Medicare Part B will cover skilled nursing facility care if you need it after COVID-19 treatment, but you will have a copayment of $176 per day after 20 days.
You also have to meet your $233 Part B deductible in 2022 and pay 20% of most covered services including doctor visits and ambulance transport.
If you have a Medigap policy, it may offset some of these out-of-pocket costs.
Medicare Advantage coverage includes everything in Part A and Part B of Original Medicare. Some services provided by Part A and B have out-of-pocket costs.
For example, hospitalization for COVID-19 symptoms is covered by Part A. Your Part A deductible, $1,556 in 2022, must be paid before Medicare begins coverage. Your first 60 days will be covered entirely once your deductible is met. After the 60 days pass, copays will be required.
Your Part B deductible of $233 applies for some services. Check with your Medicare provider since coverage varies by treatment.
Some COVID-19 services aren’t covered by Medicare Advantage at all and must be paid out-of-pocket. For example, nursing home stays, private hospital rooms and custodial care are not covered.
Check with the plan administrator for your Medigap or Medicare Advantage plan to find out exactly what your responsibilities may be if you are treated for COVID-19.
Free COVID-19 Testing Options
Other testing options include picking up free at-home tests from community health centers or Medicare-certified health clinics.
There are free monthly tests provided by the U.S. government, regardless of your insurance status. The Biden-Harris Administration announced that over 10 million COVID-19 tests will be available to schools nationwide monthly after January. The number of places to offer low-to-no-cost testing has increased exponentially since then, with over 20,000 free testing sites nationwide.
Both types of tests, rapid antigen tests and polymerase chain reaction (PCR) tests, have Medicare coverage options. PCR tests need to be processed in a lab, so it may take a few days to get results back. Your rapid antigen tests, on the other hand, don’t need to be processed in a lab, so results are typically available within 15 minutes.
Having easy access to free COVID-19 testing, either from ordering a rapid test online or going to one of the free testing sites, can provide a peace of mind to those who travel often.
The U.S. Department of Health & Human Services has an online resource tool if you need help finding a COVID-19 testing location near you. If you need additional help finding a testing location, you can also call 1-800-633-4227 for more information.
18 Cited Research Articles
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- Alltucker, K. (2022, February 3). In a Reversal, Medicare Will Cover 8 Free COVID-19 Home Tests Per Month Beginning this Spring. Retrieved from https://www.usatoday.com/story/news/health/2022/02/03/medicare-cover-free-covid-19-home-tests-starting-spring/6647349001/
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- Eli Lilly and Company. (2020, November). Fact Sheet for Health Care Providers; Emergency Use Authorization (EUA) of Bamlanivimab. Retrieved from http://pi.lilly.com/eua/bamlanivimab-eua-factsheet-hcp.pdf
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