Does Medicare Cover COVID-19 Testing and Services?
Medicare’s coverage for COVID-19 will begin to recede in 2023 as the U.S. shifts from government led initiatives to the commercial market. Learn about current and future Original Medicare and Medicare Advantage’s coverage of COVID-19 tests, treatments and vaccines to avoid unexpected costs.
- Written by Lindsey Crossmier
Lindsey Crossmier is an accomplished writer with experience working for The Florida Review and Bookstar PR. As a financial writer, she covers Medicare, life insurance and dental insurance topics for RetireGuide. Research-based data drives her work.Read More
- Edited ByLamia Chowdhury
Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.Read More
- Reviewed ByChristian Worstell
Christian Worstell is a licensed health insurance agent and an established writer in the sector, with articles featured in Forbes, MarketWatch, WebMD and more. His work has positively impacted beneficiaries nationwide and empowers them to make strong health care decisions.Read More
- Published: November 12, 2020
- Updated: January 24, 2023
- 9 min read time
- This page features 11 Cited Research Articles
- Edited By
|Medicare Plan||COVID-19 Testing Coverage|
|Part A (Inpatient)||Covers hospitalization costs if you are hospitalized with COVID-19. You are still responsible for any hospital deductibles, copays and coinsurance fees that apply.|
|Part B (Outpatient)||Covers 100% of costs of most lab tests, vaccines, boosters, antibody tests and monoclonal antibody treatment for qualifying individuals with no need to meet deductible or coinsurance.|
|Part C (Medicare Advantage)||Covers everything covered by Medicare Part A and Part B. Select plans may provide telehealth options and additional benefits.|
|Part D (Prescription Drugs)||Covers some costs for prescription drugs used to treat COVID-19. There is also potential new coverage in 2023.*|
|Supplemental Insurance||Can help cover out-of-pocket costs related to COVID-19. Coverage varies by plan.|
*Oral antiviral treatments for COVID-19 are expected to be covered by Part D once they receive FDA approval and the current federal supply is depleted.
What Does Medicare Cover for COVID-19?
Original Medicare and Medicare Advantage cover a variety of treatments, vaccines and health care services for COVID-19. 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.
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.
Older adults are at an increased risk for serious complications of COVID-19. Understanding Medicare’s coverage of testing and treatment can be critical to staying safe during the pandemic.
The public health emergency declaration for COVID-19 has provided additional coverage for COVID-19 related instances.
However, the Department of Health and Human Services will likely stop renewing the emergency declaration in 2023. The public health emergency for COVID-19 was last renewed on Oct. 13, 2022, for an additional 90 days.
|Current Coverage as of October 2022||Potential Coverage Changes After Public Health Emergency Ends|
|FDA-approved or FDA-authorized vaccines or boosters||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 Novavax. The Johnson & Johnson (Jansen) vaccine is no longer recommended by the CDC due to safety concerns.||Vaccines and boosters will still be 100% covered by Medicare.|
|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. At-home tests are covered by Original Medicare and Medicare Advantage under a Biden Administration initiative.||Original Medicare will still cover COVID-19 tests 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. However, you will pay all costs of at-home tests. With Medicare Advantage, you could face cost sharing for clinical testing for COVID-19. You could have some over-the-counter coverage for at-home COVID-19 tests.|
|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.||Original Medicare will still provide coverage for antibody tests. With Medicare Advantage, you face potential costs for an antibody test.|
|Monoclonal antibody treatment||Medicare will pay the full cost of monoclonal antibody treatments 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. Refer to CMS’s list of approved monoclonal antibody treatments, which is constantly changing. For example, bamlanivimab, etesevimab and sotrovimab are no longer authorized due to the Omicron variant.||Original Medicare and Medicare Advantage beneficiaries will face cost sharing requirements for most COVID-19 treatments, including monoclonal antibody treatments|
|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.||Medicare will continue to pay its share of hospitalization costs. You are still responsible for any hospital deductibles, copays and coinsurance that apply.|
Does Medicare Cover At-Home COVID-19 Tests?
Yes, Original Medicare and Medicare Advantage cover at-home COVID-19 tests. You can get eight tests per covered individual each month. Depending on your insurer, the tests will either be free-of-charge or you’ll be reimbursed.
You can also purchase at-home COVID-19 tests from pharmacies or retailers and be reimbursed, or they could be free.
The Biden-Harris Administration is incentivizing health plans and insurers to allow beneficiaries to pick up at-home over-the-counter COVID-19 tests for free, rather than going through the process of having to submit claims for reimbursement.
Medicare Advantage Over-The-Counter Benefit
Each Medicare Advantage plan has different OTC supplemental coverage. “While there are some plans that are increasing their OTC benefit next year (2023) to $100, even $150 a quarter, the average we see is about $45 a quarter to spend on OTC items,” Mike Jones, a Grand Anchor Insurance agent told RetireGuide.
For example, UnitedHealthcare plans cover up to $40 of OTC products per quarter. COVID-19 tests are typically around $12. This means three COVID-19 tests would be covered every three months under certain UnitedHealthcare plans.
While there are some plans that are increasing their OTC benefit next year (2023) to $100, even $150 a quarter, the average we see is about $45 a quarter to spend on OTC items.
Each plan varies, so check your OTC supplement benefits before ordering your OTC COVID-19 tests.
- Food Lion
- Giant Food
- Kroger Family of Pharmacies
- Rite Aid
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.
Remember that your coverage for COVID-19 tests and treatment will likely change once the public health emergency ends. The Kaiser Family Foundation hosted a panel of experts to discuss the future of Medicare’s coverage for COVID-19 on Oct. 19, 2022.
Jen Kates, the Executive Vice President for Health Policy with the Kaiser Family Foundation offered insight on future coverage. “It’s a bit different for treatment and tests. Under the current federal emergency situation, most can get free supplies when they are purchased from the government. However, once the public emergency ends, a lot of people could face cost-sharing. In some cases, you could be denied coverage.”
How Is Medicare Coverage of COVID-19 Changing?
Medicare’s coverage for COVID-19 will lessen in 2023 if funding isn’t provided. You’ll also have potential cost sharing, or could even be denied coverage once the public health emergency ends. Treatments and tests are most likely to face the biggest changes.
Dawn O’Connell, Assistant Secretary for Preparedness and Response of the U.S. Department of Health and Human Services, attended Kaiser’s panel of experts that discussed COVID-19 coverage. She is part of the team looking into the 2024 budget for funding. “We’re looking into the FY 2024 budget and adding The Enduring COVID Response to bridge gaps. If we don’t get additional supplemental funding, we’re exploring other options, like the Biomedical Advanced Research and Development Authority (BARDA).”
Out-of-Pocket Costs 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.
- Part A
- With Medicare Part A hospital insurance, you must pay your deductible before Medicare provides coverage. In the deductible is $1,600.
If you stay in the hospital for COVID-19 treatment for over 60 days you’ll need to pay daily copayments. From days 61 through 90, you will have to pay $400 per day. Beyond 90 days, you’ll need to pay $800 each day.
- Part B
- You need to meet your 2023 deductible before Medicare provides coverage for your COVID-19 treatments. You’ll also pay 20% of most covered services, including doctor visits and ambulance transport.
- Part C
- Part C coverage, also known as Medicare Advantage, includes everything in Part A and Part B of Original Medicare. Some services provided by Part A and B have out-of-pocket costs.
However, 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.
If you have a Medigap policy, it may offset some of these out-of-pocket costs.
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
Although the free mailed Covid-19 test program was suspended on Sept. 2, 2022 — it’s now available again as of Dec. 2022. You can order four rapid COVID-19 tests to your front door for free at COVID.gov. This next round of tests should start shipping during the week of Dec. 19.
There are over 15,000 free COVID-19 testing sites in the U.S. Even if you are uninsured, you can still get free testing.
The U.S. Department of Health & Human Services has an online resource tool if you need help finding a free 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.
You can also be reimbursed for eight at-home COVID-19 tests per month. In some cases, your insurer will allow you to skip the reimbursement process and the test will be free of cost at the time of purchase.
You’ll also face no costs if you get tested for COVID-19 from a laboratory, pharmacy, doctor or hospital — as long as the COVID-19 public health emergency is still in effect.
11 Cited Research Articles
- NPR. (2022, December 15). You Can Order Free COVID Tests Again by Mail. Retrieved from https://www.npr.org/2022/12/15/1142926180/free-covid-tests-mail-order
- Centers for Disease Control and Prevention. (2022, November 1). Stay Up to Date with COVID-19 Vaccines Including Boosters. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html
- U.S. Centers for Medicare & Medicaid Services. (2022, November 1). COVID-19 Monoclonal Antibodies. Retrieved from https://www.cms.gov/monoclonal
- Kaiser Family Foundation. (2022, October 18). Commercialization of COVID-19 Vaccines, Treatments and Tests: Implications for Access and Coverage. Retrieved from https://www.kff.org/coronavirus-covid-19/issue-brief/commercialization-of-covid-19-vaccines-treatments-and-tests-implications-for-access-and-coverage/
- American Hospital Association. (2022, October 13). HHS Renews COVID-19 Public Health Emergency for 90 Days. Retrieved from https://www.aha.org/news/headline/2022-10-13-hhs-renews-covid-19-public-health-emergency-90-days
- Kaiser Family Foundation. (2022, October 13). Oct. 19 Web Event: The Commercialization of COVID. Retrieved from https://www.kff.org/coronavirus-covid-19/event/october-19-web-event-commercialization-covid/
- United HealthCare Services. (2022, October 10). OTC Credit with Medicare Advantage Plans. Retrieved from https://www.uhc.com/medicare/shop/medicare-advantage-plans/otc-benefits.html
- U.S. Centers for Medicare & Medicaid Services. (2022, January 12). How To Get Your At-Home Over-the-Counter COVID-19 Test for Free. Retrieved from https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free
- National Council on Aging. (2022, January 3). Get the Facts on Medicare Coverage for COVID-19. Retrieved from https://www.ncoa.org/article/medicare-coverage-for-covid-19-get-the-facts
- U.S. Department of Health and Human Services. (2022). Testing Resources. Retrieved from https://www.covid.gov/tests
- U.S. Centers for Medicare & Medicaid Services. (2019). Coronavirus Disease 2019 (COVID-19) Diagnostic Tests. Retrieved from https://www.medicare.gov/coverage/coronavirus-disease-2019-covid-19-diagnostic-tests
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