Medicare Coverage for COVID-19

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It’s scary to think about getting sick with COVID-19. Seniors and caregivers are also worried about what insurance will cover related to coronavirus and how to safely access routine medical care and prescription drugs. MedicareFAQ explains the changes that Medicare has made to help beneficiaries get the health care they need during this national health emergency.


The spread of COVID-19 throughout the United States is a scary reality for all of us and especially for those who are most vulnerable due to age or existing health conditions.

To help seniors during the pandemic, Medicare has acted quickly to make sure that all beneficiaries will have the coverage they need if they should become ill from the coronavirus.

Because the situation is changing so rapidly, Centers for Medicare & Medicaid Services (CMS) continues to update their policies to increase access to health care during these uncertain times. 

Here, we highlight the changes made in April to Medicare coverage due to the coronavirus pandemic, but please continue to check here for updates as CMS releases new information and resources.


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Coronavirus testing will be covered

As a crucial first step, CMS announced that Medicare will provide full coverage for COVID-19 testing under Medicare Part B for those who have been or will be tested after February 4, 2020. 

People with Medicare Advantage will also be fully covered since all Advantage plans are required to provide coverage for all care/services covered by Parts A and B. 

Additionally, CMS has eliminated any and all cost-sharing associated with coronavirus testing, including deductibles, copays, and coinsurance.


Coronavirus treatment coverage varies

If you become infected with the coronavirus, coverage for treatment varies depending on your plan and whether you receive care in an inpatient or outpatient facility.

Inpatient treatment
Treatment provided in an inpatient setting falls under Part A. 

That means that those admitted to a hospital during this time will need to pay the Part A deductible (currently $1,408) in addition to any co-pays for lengthened stays. 

If you’re enrolled in a Medigap plan, you will receive coverage for the deductible as well as any copays for extended hospitals stays up to one year.

Outpatient treatment
If you receive treatment in an outpatient setting, that will fall under part B. 

In this instance, you will be responsible for both the Part B deductible and the 20% coinsurance. 

If you have a Medigap plan, the 20% coinsurance will be covered, but receiving coverage for the deductible will depend on which plan you have.

If you have a Medicare Advantage plan, what you will be required to pay out-of-pocket is contingent upon your plan carrier and their policies for copays and coinsurance.


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Section 1135 waiver benefits

CMS has also issued the Section 1135 waiver to provide flexibility and prevent gaps in coverage so all beneficiaries can access health care during this crisis.

And under the Section 1135 waiver, CMS has waived restrictions related to out of network coverage and telehealth services. 

Out of network restrictions waived
Out of network coverage restrictions mainly apply to stand-alone prescription drug plans and Medicare Advantage plans since they are private plans that limit the ability to receive coverage for care/services from out of network providers.

During this pandemic, Medicare Advantage plans are required to cover services related to COVID-19 that are administered by providers outside of their network and to charge the same amount for these respective services as they would for in-network providers.

Additionally, Part D plans are now required to ensure that all enrollees have access to their medications from both in-network and out-of-network pharmacies, and are providing flexibility in terms of medication delivery, including via mail and home delivery.

Telehealth service restriction waiver
Regarding restrictions on telehealth services, all virtual check-ins and e-visits are accessible to all beneficiaries free of charge or at a reduced cost-sharing amount during this emergency. 

It’s important to note that use of telehealth services during this time are not restricted to only coronavirus related issues, but also include preventative health screening, mental health counseling, and regular office visits.


Keep checking with CMS and insurance providers

During this health crisis, it’s important to understand how your insurance coverage may impact your access to necessary healthcare.

Check in with CMS or your private plan provider if there is any uncertainty surrounding your policies and follow updates from the CDC and WHO for developments related to protection against the coronavirus.


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Guest contributor: Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare space since 2017. She is featured in many publications as well as writes regularly for other expert columns. She has a passion for sharing her expertise on Medicare to beneficiaries so they can be better prepared for healthcare costs after retirement. You can find her on YouTube where she has a featured channel for Medicare beneficiaries to become educated on all their options.


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