Last Updated: 3/31/2020
Below is a guide to help Medicare beneficiaries stay informed and better protect themselves against the novel coronavirus (COVID-19), including how Medicare coverage can help.
Original Medicare (Medicare Part A and Part B) and some private Medicare Advantage (Medicare Part C) plan carriers are responding to the pandemic in a number of ways.
Additionally, some Medicare Advantage plan carriers are also offering benefits such as:
Check with your Medicare Advantage plan carrier to find out what benefits are currently available to you.
Medicare does cover telehealth services related to COVID-19. In fact, the Centers for Medicare & Medicaid Services (CMS) has actually expanded Medicare coverage of telemedicine services due to the outbreak.
Health care providers can conduct video consultations with patients who are experiencing symptoms consistent with COVID-19. This allows seniors to remain in the safety of their home while receiving care, as opposed to risking the contraction or spread of the infection by visiting a doctor’s office.
When COVID-19 was declared a national emergency, the rules for refilling certain prescription medications were loosened.
Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage are now allowed to relax their “refill-too-soon” restrictions. This allows beneficiaries to stock up on an extended supply of their medications.
Because the COVID-19 outbreak was declared a national emergency, Medicare Advantage and Medicare Part D beneficiaries are able to receive qualified care outside of their plan’s network, if their Part D plan or Medicare Advantage plan includes a network of providers.
During the period of declared emergency, Medicare Advantage plans are required to cover services at out-of-network facilities that participate in Medicare and charge the beneficiary a rate that is no more than what they would have paid at an in-network facility.
Part D plans must also ensure members have adequate access to covered medications at out-of-network pharmacies when the use of an in-network facility cannot be reasonably expected.
Part D plans are also given freedom to relax rules about mail-delivered medications.
There is currently no vaccine treatment for COVID-19. People who are infected with the virus can only be treated for the symptoms it causes.
Any treatment administered for the symptoms of COVID-19 will be covered in the same way those services and items are already covered by Medicare.
The treatment methods being used to address the symptoms of COVID-19 include:
Medications used to treat a fever may be covered by a Medicare Part D prescription drug plan or a Medicare Advantage plan that includes prescription drug benefits.
Supplemental oxygen is typically covered by Medicare Part B. Medicare Part A covers inpatient hospital stays, while outpatient visits are covered by Part B.
If you are admitted for inpatient hospital care, your Medicare Part A deductible applies. The Part A deductible is $1,408 per benefit period in 2020.
If you receive medical care for symptoms of COVID-19, you’re typically responsible for 20 percent of the Medicare-approved amount for covered services after you meet your Part B deductible. In 2020, the Part B deductible is $198 per year.
There is not currently a vaccine for COVID-19.
The first clinical trial for a COVID-19 vaccine got underway on March 17. Senate minority leader Chuck Schumer previously called on Medicare to provide coverage for a novel coronavirus vaccine when one becomes available.
Yes. Due to the novel coronavirus outbreak, the CMS has implemented the following Medicare nursing home guidelines:
Nursing homes are also taking extra steps as recommended by the Centers for Disease Control and Prevention (CDC), including stocking extra soap and sanitizer and making face masks, disinfectant and personal protective equipment readily available.
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Coronaviruses are a large family of viruses that cause anything from the common cold to more severe diseases like Severe Acute Respiratory Syndrome, or SARS.
Novel coronavirus is a new strain that has not been previously identified in humans. This strain leads to a disease called COVID-19.
Coronaviruses are zoonotic, meaning they are transmitted to humans from animals.
For example, SARS was initially transmitted from a cat, and MERS (Middle East Respiratory Syndrome) was first transmitted to humans from a camel.
It is not yet known which animal may have been the source for the newest strain of coronavirus, but it first surfaced in the Chinese city of Wuhan (which has a population of over 11 million people) in December.
Once coronavirus is transmitted to humans, it spreads from person to person through respiratory droplets that are coughed, sneezed or exhaled into the air by the infected person and inhaled by another. These droplets can be inhaled by anyone within approximately six feet of an infected person.
Coronavirus can also live on surfaces such as door handles or tables and be spread by touching your mouth or nose after coming into contact with the infected surface.
It is estimated that each infected person will infect on average 2-3 additional people. It is currently believed that only those who are experiencing symptoms may transmit the disease or at the least, those with the most symptoms are the most contagious.
Older adults and those with underlying medical conditions such as diabetes, high blood pressure, cardiovascular disease, respiratory disease and cancer are most at risk.
A study in China showed that the average age to develop acute respiratory distress syndrome –or severe shortness of breath that requires the use of a ventilator – as a result of coronavirus is 61 years old.1
Older adults may also be at a higher risk of being exposed to the coronavirus. Millions of seniors reside in senior living communities, assisted living homes or nursing homes, putting them in close contact with other seniors.
Most of the first-reported COVID-19 deaths in the U.S. have been traced to a nursing home in Seattle, Washington.
Children appear to be at less of a risk. One study from the China Center for Disease Control and Prevention (CCDC) found that just 2% of coronavirus cases affected children under 18 years old, and of those, only around 3% developed a severe case of COVID-19.2
Coronavirus infection symptoms typically appear 2-14 days after exposure to coronavirus and include:
COVID-19 may also bring persistent pain or pressure in the chest and a bluish discoloration in the lips or face.
More severe cases can cause pneumonia, severe acute respiratory syndrome, kidney failure and death.
The mortality rate for COVID-19 has been estimated at just over 4%, though that number may exaggerate the lethality of the disease, as not all cases of infection are reported.3
Some people who have tested positive for the coronavirus have shown only mild symptoms or no symptoms at all.
There is no current treatment for the coronavirus or COVID-19 itself. Infected persons are treated for their symptoms, such as taking steps to alleviate their fever and suppress their cough.
Supportive care such as oxygen therapy and fluid management can also be effective treatment for symptoms.
Coronavirus testing has been made free for people in the United States who have health insurance.
There are a few different ways to test for COVID-19.
Only certain facilities have been approved for coronavirus testing. If your health care provider thinks you should be tested for coronavirus, they will contact the Centers for Disease Control (CDC) and refer you to a facility approved for testing.
Coverage of the test is protected as an essential health benefit as dictated by the Affordable Care Act.
The coronavirus test is covered by Medicare Part B, and you will pay nothing out-of-pocket for it if you are a Medicare beneficiary.
There are no FDA-approved vaccines for COVID-19 as of March 31, 2020.
There are at least nine companies in the U.S. that are actively working toward the development of a vaccine, some of which are being backed by government funding. A working vaccine is likely at least a year or more away from being available for widespread distribution.
Senate Minority Leader Chuck Schumer has called on Medicare to provide coverage for a coronavirus vaccine, should one become available.
There are a number of things seniors can do to reduce their risk of exposure to the coronavirus.
Face masks may help prevent the spread of the coronavirus from infected people. However, they are not believed to reduce the odds of contracting the coronavirus.
As of March 31, 2020, the novel coronavirus (COVID-19) has infected 163,539 Americans, resulting in 2,860 total deaths.4
Refer to the list below to stay up to date on the latest news related to COVID-19, the current coronavirus pandemic and what you may need to know as a Medicare beneficiary.
Be sure to check back in with this list so that you don't miss important updates.
The COVID-19 pandemic has the potential to inflate Medicare spending by up to $115 billion over the next year, according to a recent study released by the National Association of Accountable Care Organizations.
Medicare completed an inspection of the nursing home in Kirkland, WA, that was the epicenter of the novel coronavirus outbreak.
Medicare is easing the burden being faced by doctors during the coronavirus (COVID-19) outbreak by extending the deadline for quality reporting measures.
The deadline for reporting results has been extended in order to allow doctors on the front lines of the outbreak to focus on patient care.
Some Medicare beneficiaries and other seniors are currently being targeted by scams such as the selling of fake COVID-19 tests and vaccines.
The Centers for Medicare & Medicaid Services (CMS) has urged hospitals to delay nonessential surgeries to free up staff and resources for the wave of COVID-19 patients.
The Centers for Medicare & Medicaid Services will expand telemedicine services coverage nationwide in an effort to help seniors receive medical attention from the safety of their own homes and to help curb the spread of the novel coronavirus (COVID-19).
Medicare is taking steps to keep nursing home residents safe amid the COVID-19 outbreak. Because nursing home residents are older and in close proximity to other older adults, nursing homes have become a dangerous breeding ground for the virus.
Declaring the outbreak of COVID-19 a national emergency opened some doors for Medicare to take more aggressive steps in its fight against the pandemic.
Medicare recently released details about how COVID-19 testing would be reimbursed to health care providers administering the tests.
In the wake of the novel coronavirus pandemic, the CMS released guidance on how Medicare Advantage and Medicare Part D prescription drug plans can properly respond to the outbreak.
Vice President Mike Pence announced during a March 4 press briefing that the test for COVID-19 will be covered by Medicare and Medicaid, in addition to private insurance.
Schumer called for Medicare to cover the vaccine when one does become available, saying at a press conference that his plan to have Medicare fully cover the cost of the vaccine “will mean no senior will be forced to make the choice between shelling out and going without.”
|3/26/2020||Study: Medicare Spending Could Reach $115 Billion on COVID-19 Care|
|3/26/2020||Medicare Investigation of Kirkland, WA, Nursing Home Results in New Inspection Protocols|
|3/25/2020||Medicare Beneficiaries Targeted by Scams During Coronavirus (COVID-19) Outbreak|
|3/19/2020||Medicare to Hospitals: Halt Nonessential Surgeries and Dental Care in Wake of COVID-19 Outbreak|
|3/18/2020||Medicare Expands Telemedicine Coverage in Fight Against COVID-19|
|3/18/2020||CMS Takes Measures to Help Nursing Homes in Fight Against COVID-19|
|3/17/2020||Declaration of Emergency for COVID-19: What Does It Mean for Medicare?|
|3/16/2020||Medicare Announces Reimbursement Rates for Coronavirus Testing|
|3/16/2020||Federal Medicare Coronavirus Guidance for Private Insurance Plans|
|3/9/2020||Coronavirus Test to be Covered by Medicare|
|3/5/2020||Coronavirus and Medicare | Senator Schumer Calls for Medicare to Cover Vaccine|
Below are some resources for updated news, information and tips about the coronavirus and COVID-19 that may be helpful to seniors: