Published May 1, 2020
Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.
While there is no cure for COVID-19 or vaccine for the novel coronavirus, there are effective treatments for many of the disease’s symptoms.
How much can a Medicare beneficiary expect to pay for COVID-19 treatment? Let’s break it down based on the various types of Medicare coverage.
To investigate the type of expenses that a Medicare beneficiary may incur as a result of a COVID-19 infection, we’ll examine how different types of Medicare coverage might be involved in treatment steps such as:
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Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance).
To illustrate how Original Medicare might pay for COVID-19 testing and treatment, we’ll use a hypothetical example of a Medicare beneficiary named “John.” John has Medicare Part A and Part B, but no other supplementary insurance.
John eventually recovers from the disease, but he faced a few costs along the way. Here is a breakdown of John’s total out-of-pocket Medicare spending:
All told, John is likely responsible for at least $1,872 for his doctor’s appointment and hospital admission alone (because of the Part A and Part B deductible requirements). On top of that, he’ll be responsible for 20% of his emergency room visit and all costs of his medications.
In this hypothetical example, it’s likely that John’s coronavirus infection will cost him around $2,000 or more.
Medicare Advantage plans (Medicare Part C) are sold by private insurance companies and are required by law to provide all of the same benefits as Medicare Part A and Part B, and plans can offer more benefits that Original Medicare (Parts A and B) does not cover.
Medicare Part D plans provide coverage exclusively for prescription medications and can be used alongside Original Medicare.
Let’s examine another hypothetical example.
“Tom” has Original Medicare and a Medicare Part D prescription drug plan.
Here is a breakdown of some of Tom’s out-of-pocket Medicare costs for coronavirus treatment:
Tom may have to meet a small deductible for his prescription drugs, and may even have a copayment requirement. The amount of his Part D deductible and copay costs will vary, depending on the plan he has.
Tom can, however, expect to pay for slightly fewer out-of-pocket expenses for his COVID-19 experience than John, since he has a Part D plan that covers his prescribed medication.
Medigap, or Medicare Supplement Insurance, is a supplementary form of coverage that is used alongside Medicare Part A and Part B.
Medigap plans can help cover the cost of certain out-of-pocket Medicare costs like deductibles, copayments and coinsurance.
Medicare Supplement plans and Medicare Advantage plans are not the same thing. You cannot have both Medicare Supplement Insurance and a Medicare Advantage plan at the same time.
Let’s consider another hypothetical example, this time using “Jane” to illustrate how Medigap plans can help cover Medicare costs. In this example, Jane has Original Medicare and Medigap Plan F, which covers more costs than any other type of standardized Medigap plan.
Here is a breakdown of Jane’s total out-of-pocket spending:
Because Jane incurred no charges for her doctor appointment, emergency room visit or hospital stay, her bout with COVID-19 cost her far less in out-of-pocket Medicare costs than John, Tom or Nancy paid.
It should be noted that Jane still is responsible for paying her monthly Medigap plan premium.
Let’s consider one final hypothetical example. Let’s imagine “Bill” has Original Medicare, a Medicare Part D plan and Medigap Plan F. Let’s also imagine that his coronavirus infection treatments are the same as for the examples provided above.
Here is a breakdown of Bill’s total out-of-pocket spending:
Bill paid the least out of pocket for his COVID-19 treatment out of any of our examples above. Again, however, it should be noted that Bill pays monthly premiums for his Part D plan, his Medigap plan and for Medicare Part B.
Medicare beneficiaries can have very different experiences with COVID-19 treatment costs, based on the type of Medicare coverage they have.
Is the COVID-19 pandemic making you rethink your Medicare coverage strategy? You can call today to speak with a licensed insurance agent who can help you compare Medicare Advantage plans available where you live.
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Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.