Medicare Coverage During COVID-19

Medicare covers medically necessary items and services related to coronavirus when you receive care from a provider who accepts Original Medicare or is in-network for your Medicare Advantage Plan. Medicare has also changed certain coverage requirements in response to the current coronavirus public health emergency.

Note: Medicare Advantage Plans must cover everything that Original Medicare does, but they can do so with different costs and restrictions. Additionally, Medicare Advantage and Part D plans must meet certain requirements following the declaration of a public health emergency.

Coronavirus testing

Coronavirus testing is covered under Medicare Part B. Your doctor can bill Medicare for tests provided after February 4, 2020.

Original Medicare covers coronavirus testing and associated provider visits at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover coronavirus testing without applying deductibles, copayments, or coinsurance when you see an in-network provider.

COVID-19 vaccine

Original Medicare Part B covers the vaccine, regardless of whether you have Original Medicare or a Medicare Advantage Plan. You may owe no cost-sharing (deductibles, copayments, or coinsurance), as most expenses are covered.

Inpatient hospital care

Inpatient hospital care is covered under Medicare Part A, and standard coverage rules and cost-sharing apply. Medicare typically covers a semi-private room, but it should cover a private room when it is medically necessary. For example, if you need a private room in order to be quarantined, you should not be asked to pay an additional cost for the private room. If you have a Medicare Advantage Plan, you should contact your plan to learn about its cost sharing and coverage rules for inpatient hospital stays.

Skilled nursing facility (SNF) care

Part A typically only covers skilled nursing facility care if you were formally admitted as an inpatient to a hospital for at least three consecutive days. Currently, Medicare has removed the three-day hospital stay requirement if you are affected by the coronavirus public health emergency. For example, Part A may cover your SNF care without a three-day stay if you were transferred due to a nursing home evacuation or to make room at a local hospital, or if you need care because of the current public health emergency.You do not have to have COVID-19 or a condition related to COVID-19 in order for this change to apply.

Keep in mind that this change does not apply to all situations. You must have been affected by the coronavirus public health emergency to receive covered SNF care without a prior three-day hospital stay.

Medicare has also changed other SNF requirements. Typically, Part A covers up to 100 days of SNF care each benefit period. A benefit period begins when you are admitted to the hospital as an inpatient, or to a SNF, and it ends when you have been out of the SNF for at least 60 days in a row. After your benefit period has ended, you receive another 100 days of SNF care at the start of a new benefit period. If you are unable to end a benefit period and start a new one because of the public health emergency, you can get another 100 days of covered SNF care without having to begin a new benefit period.

Physician's services in the home

Part B covers services you receive from a physician (or other provider, such as a registered nurse) who visits your home. Part B also covers some services that are not provided face-to-face with a doctor, such as check-in phone calls and assessments using an online patient portal. Virtual check-ins can be used to assess whether you should go to your doctor's office for an in-person visit.

Telehealth services

Medicare generally only covers telehealth in limited situations, but has expanded coverage and access during the public health emergency.

Medicare covers your hospital and doctors’ office visits, behavioral health counseling, preventive health screenings, and other visits via telehealth in settings that include your home. Telehealth services can also be used for the face-to-face visits required for home health care and hospice care. Standard cost-sharing may apply. If you have a Medicare Advantage Plan, you should contact your plan to learn about its costs and coverage rules.

Certain telehealth services can now be delivered using only audio, including:

• Counseling and therapy provided by an opioid treatment program
• Behavioral health care services
• Patient evaluation and management

If you have questions about technology requirements for telehealth services, you should ask your provider.

Home health care

Medicare covers home health care if you are homebound, need skilled nursing or therapy care, and are prescribed home health care after a face-to-face visit with your doctor. During the public health emergency, some of these coverage requirements have been changed.

• The homebound requirement can be met in additional ways: You can be considered homebound if your physician certifies that you cannot leave your home because you are at risk of medical complications if you go outside, or if you have a suspected or confirmed case of COVID-19. If you also need skilled care at home, you can qualify for the home health care benefit.
• Other providers can prescribe home health care: Usually, a doctor has to prescribe home health care, but during the public health emergency other providers, including nurse practitioners and physician assistants, can prescribe the care, too. The face-to-face visit requirement can be met through telehealth.
• Agencies can offer more services through telehealth: Home health care agencies can provide more services via telehealth, as long as the services are listed on your plan of care. The telehealth services may be used in place of in-person services listed on your plan of care.

Prescription refills

During the emergency, all Medicare Advantage and Part D plans must cover up to a 90-day supply of a drug when requested. Plans cannot use quantity limits on drugs that would prevent you from getting a 90-day supply, if you have a prescription for that amount. However, some safety limits are still in place to prevent unsafe doses of opioids.

Note: If you take medications that are covered by Part B, you should ask your doctor and plan for more information about ensuring you have an adequate supply.

© Medicare Rights Center. Used with permission.

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