How Do Different Parts of Medicare Cover Coronavirus (COVID-19) Treatment Costs?

• by Christian Worstell
• November 9, 2023

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.

How is COVID-19 treated? 

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:

• Seeing a doctor because of symptoms
• Getting a referral from your doctor for a COVID-19 test and undergoing the test
• Being admitted to the hospital
• Taking medications

Original Medicare and coronavirus costs

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 comes down with symptoms similar to COVID-19 infection and schedules an appointment to see his doctor (who accepts Medicare).
  
  The appointment is covered under Medicare Part B, but John is first responsible for meeting his annual Part B deductible, which is $240 in 2024.
  
  If the cost of the appointment is greater than $240, or if John already met his Part B deductible earlier in the year, he will typically pay a 20% coinsurance for the remaining costs. 
  
  
• John is examined by his doctor, who refers John to be tested for COVID-19. John then visits a testing facility where he tests positive for the disease.
  
  Medicare Part B covers FDA-authorized COVID-19 diagnostic testing in full when ordered by a health care provider and administered by a laboratory or hospital that accepts Medicare. Because Medicare covers the COVID-19 test in full, John owes nothing out-of-pocket for the test.
  
  
• After testing positive, John returns home to recuperate. He takes some over-the-counter aspirin for his fever, he takes over-the-counter asthma medication to open up his breathing and he takes over-the-counter cough medicine (fever, cough and shortness of breath are the three main symptoms of COVID-19).
  
  Over-the-counter drugs are not covered by Medicare, so John must pay out of pocket for these drugs.
  
  
• After a few days, John’s condition is worsening so he visits the emergency room. If he met his Part B deductible, John’s now most likely responsible for a 20% coinsurance payment for the cost of the emergency room visit. 
  
  
• John is examined in the ER by a doctor and admitted to the hospital as an inpatient.
  
  Upon admission to the hospital, John begins a benefit period where he is responsible for meeting a $1,632 deductible (in 2024) before Medicare Part A starts paying its share of his inpatient hospital costs.
  
  Once he meets that deductible, he does not owe any Part A coinsurance amount, unless his stay lasts longer than 60 days. John spends a week at the hospital receiving treatment and is sent home to finish his recovery. 
  
  
• Upon discharge from the hospital, John is prescribed medication to further help with his cough and breathing. Original Medicare does not cover prescription drugs taken outside of the hospital, so John must pay for his drugs out of his own pocket.

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:

• Medicare Part B deductible ($240 in 2024)
• Medicare Part A deductible ($1,632 per benefit period in 2024)
• 20% of the cost of his emergency room visit
• 100% of the cost of his over-the-counter (OTC) drugs
• 100% of the cost of his prescription drugs

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 and Part D prescription drug plans and COVID-19 costs

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. 

• Tom’s COVID-19 experience is very similar to John’s, as outlined above. Tom is responsible for paying the Part A and B deductibles and Part B coinsurance for the emergency room visit.
  
  
• Tom’s Medicare Part D plan, provides coverage of the drug that he was prescribed to help with this breathing. His Part D plan does not, however, cover the cost of over-the-counter drugs.

Here is a breakdown of some of Tom’s out-of-pocket Medicare costs for coronavirus treatment:

• Medicare Part B deductible ($240)
• Medicare Part A deductible ($1,632)
• 20% of the cost of his emergency room visit
• 100% of the cost of his over-the-counter drugs

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.

Medicare Supplement Insurance (Medigap) and COVID-19 costs

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. 

• Jane’s Medigap plan provides full coverage of the Medicare Part B deductible and coinsurance, so she pays nothing out of pocket for her initial trip to the doctor.
  
  
• Jane spends a few days at home taking over-the-counter drugs. Her Medigap plan doesn’t cover any prescription or over-the-counter drugs, so she must pay for these entirely out of pocket. Standardized Medigap plans do not cover prescription drugs. 
  
  
• Jane visits the emergency room as her symptoms worsen. Because her Medigap plan covers the Part B coinsurance in full, she pays nothing for the visit.
  
  
• Her Medigap plan also provides full coverage of the Part A deductible, which means she pays nothing for her hospital stay when she is admitted for inpatient care.
  
  
• Upon discharge, Jane must pay out of pocket for her prescription drugs. 

Here is a breakdown of Jane’s total out-of-pocket spending:

• 100% of the cost of her over-the-counter drugs
• 100% of the cost of her prescription drugs

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.

Paying for COVID-19 treatment if you have Original Medicare, a Part D plan and Medigap

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.

• Like Jane, Bill’s Medigap plan provides full coverage of the Medicare Part B deductible and coinsurance, so he pays nothing out of pocket for his doctor’s office visit when he first exhibits symptoms of COVID-19.
  
  
• Bill is admitted for inpatient hospital care due to his COVID-19 infection. His Medigap plan pays for his Part A deductible, Part A coinsurance and any additional Part B copay/coinsurance costs during his inpatient hospital stay.
  
  
• Bill is discharged after recovering, and he is prescribed medication to help him continue recovery. Because Bill has a Part D plan, he does not have to pay for his prescription drugs in full out of his own pocket. Bill simply pays a small deductible and minor copayments for drugs covered by his Part D plan.
  
  
• Not all Part D plans offer over-the-counter benefits, so Bill will typically still have to pay out-of-pocket for those.

Here is a breakdown of Bill’s total out-of-pocket spending:

• 100% of the cost of his over-the-counter drugs

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.

Find the right Medicare coverage for you

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.

About the author

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.

 

 

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