Last Updated: 10/22/2020
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.
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.
Many 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 around 3.3%, 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.
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 October 21, 2020, the novel coronavirus (COVID-19) has infected 8,249,011 Americans, resulting in 220,362 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.
Labs that return COVID-19 test results in two days or less will receive a higher reimbursement amount from Medicare than labs that give slower results.
Nearly 6 out of 10 Americans believe Medicare and private health insurance should bear more responsibility for covering the cost of long-term care. 56% say Medicare specifically should pay more.
A recent study shows private employers are increasingly in favor of government intervention into health insurance, including Medicare expansion and drug price regulation.
Seniors on Medicare may receive $200 gift cards for prescription drugs as part of President Trump’s America First Healthcare Plan.
COVID-19 has made nursing homes a more dangerous place for older Americans. Some additional funding for a key Medicaid program aims to help.
Data from the CMS projects Medicare Advantage premiums to drop in 2021 while plan selection and enrollment continue to increase.
Considerably more Medicare Advantage (Part C) plans will offer supplemental benefits for in-home care services in 2021 than ever before.
A recent report highlights how much money Medicare saves when surgeries are performed at an ambulatory surgical center instead of a hospital outpatient facility. Future savings are expected to grow.
The repayment of more than $100 billion worth of Medicare loans handed out to hospitals as part of COVID-19 relief efforts may be extended and relaxed as part of recent legislation.
The CARES Act states that if a vaccine for COVID-19 becomes available, it will be covered by Medicare. But a technicality potentially stands in the way of that happening.
Medicare has issued a message to hospitals: Report your COVID-19 data or risk losing your Medicare reimbursement payments.
The Centers for Medicare & Medicaid Services updated their guidelines for nursing home visitation including outdoor visits and clarified definitions of compassionate care for indoor visits during COVID-19.
Nursing homes have been granted a 2.2% Medicare pay raise for fiscal year 2021.
The federal government granted $100 billion in Medicare loans to hospitals to keep them afloat during the COVID-19 crisis. Those hospitals are now asking for forgiveness of the loans.
The White House issued an executive order in an attempt to lower Medicare drug costs. The order forces drug makers to use foreign drug pricing as a benchmark for how drugs are priced in the U.S.
A new Medicare proposal incentivizes the development of innovative home dialysis machines in hopes of allowing more beneficiaries with ESRD to receive treatment from home.
A second coronavirus relief package – the proposed HEALS Act – may contain some provisions that impact Medicare.
COVID-19 has disrupted the health insurance coverage of many older adults. Here are the answers to some common insurance questions facing older adults in 2020.
Face mask have become part of our everyday wardrobe during the coronavirus (COVID-19) pandemic. It's especially important for older adults to select the right mask, wear it correctly and wash it regularly.
Remdesivir has been used to successfully treat some patients with severe symptoms of COVID-19. The Chairman and CEO of Gilead Sciences recently commented on the costs Medicare beneficiaries and people with private insurance will face for remdesivir treatment.
Black Medicare beneficiaries are hospitalized for COVID-19 almost four times as frequently as Caucasian beneficiaries, and Hispanic Americans enrolled in Medicare are more than twice as likely as Caucasians to be hospitalized for the disease.
The coronavirus (COVID-19) outbreak may have disrupted Medicare enrollment for some beneficiaries, so the Centers for Medicare & Medicaid Services (CMS) has issued a pair of Special Enrollment Periods.
Different types of Medicare coverage can help pay for COVID-19 treatment in different ways.
Certain pre-existing conditions can increase the risk for serious health complications as a result of COVID-19.
The COVID-19 pandemic has forced many people into isolation. Some Medicare beneficiaries may have at-home options for things like mail-order prescription drugs.
If you lose employer health insurance during the COVID-19 outbreak, and if you didn’t enroll in Medicare at age 65 because you were still covered by your employer’s health insurance plan, you may qualify for a Special Enrollment Period.
All of the Social Security offices in the U.S. are now closed because of the COVID-19 pandemic. This may have many people wondering how their enrollment or current benefits may be affected, or how they can get answers to their Social Security and Medicare questions.
The federal government will issue stimulus checks to millions of Americans to help keep the economy afloat during the COVID-19 outbreak.
Several private Medicare plan providers, including Cigna, Humana and Aetna, have taken measures to reduce or eliminate out-of-pocket costs (such as copays and deductibles) for plan beneficiaries who undergo treatment for COVID-19.
The Coronavirus Aid, Relief and Economic Security (CARES) Act economic stimulus package is set to make a sizable impact on the health care industry in America.
The Centers for Medicare & Medicaid Services (CMS) has approved the Medicaid waiver requests of 29 states under section 1135 of the Social Security Act in response to the COVID-19 outbreak.
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 in America.
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.”
Below are some resources for updated news, information and tips about the coronavirus and COVID-19 that may be helpful to seniors:
1 Yanli Liu, et al. (Feb. 27, 2020). Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019. medRxiv. https://doi.org/10.1101/2020.02.17.20024166.
2 The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.
3 Worldometer. COVID-19 Coronavirus Outbreak. Retrieved September 2 from www.worldometers.info/coronavirus.
4 Center for Disease Control and Prevention (CDC). (Oct. 20, 2020). Coronavirus Disease 2019 (COVID-19) in the U.S. Retrieved October 21 from www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html.