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Medicare and COVID-19: What You Need to Know

As of early June 2020, the United States had a total of 1,914,054 confirmed COVID-19 cases.

By: Danielle Roberts | Jun 2020

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COVID-19 Illustration COVID-19 Illustration photo by csp_ra2studio

Even though the Centers for Disease Control and Prevention (CDC) has noted that the rate of positive tests for COVID-19 continues to decrease or stay stable from week to week, there are still thousands of people hospitalized throughout the country.

The age group with the most hospitalizations per 100,000 people is 65+ years. Seniors have been most heavily impacted by this pandemic and are still at a high-risk for developing COVID-19. With Medicare being the primary insurer among these COVID-19 patients, it has established extensive coverage for all things medically related to the coronavirus.

While the death rates have been on a declining slope for the past five weeks, according to the CDC, the country is not out of the woods quite yet. Here’s what you need to know about COVID-19 and Medicare.

The history of coronaviruses

When the COVID-19 pandemic first erupted, many people thought this was the first coronavirus known to mankind. Contrary to popular belief, scientists discovered the first coronaviruses that affected humans in the 1960s. The CDC has identified seven coronaviruses that can infect humans, with SARS-CoV-2 being the most recent discovery.

Three of the seven coronaviruses initially infect animals, who then pass an evolved virus onto humans (MERS-CoV, SARS-CoV, and SARS-CoV-2). In 2003, SARS-CoV was first detected in Asia and grew to be a multi-continent epidemic called a pandemic. This coronavirus stopped spreading later that year. The next coronavirus pandemic was MERS-CoV in 2012, a virus that was first reported in Saudi Arabia when a camel infected a human.

SARS-CoV-2 and COVID-19

Fast forward to 2019, and you’ll find SARS-CoV-2, the coronavirus that causes the COVID-19 disease. Symptoms of COVID-19 include fever, chills, shortness of breath, cough, body aches, loss of smell and taste, fatigue, and more. This virus is a scary thing since the symptoms are very similar to those of the common flu and some people never show any signs. It spreads mostly through close person-to-person contact and both those who show and don’t show symptoms can spread the virus to other humans. COVID-19 lives in respiratory droplets, and when they land on or are inhaled by another person, the infection can spread.

While some viruses aren’t highly contagious, COVID-19 is, as we’ve seen from data. The virus spreads easily and doesn’t lose its strength from person to person, unlike a stomach bug that spreads fast then quickly dies off.

People most at risk of COVID-19

COVID-19 does not discriminate. People of all ages from all walks of life have become infected with with the virus over the past several months. While everyone is at risk of SARS-CoV-2, certain groups are less likely to fight off the disease. Seniors and those with pre-existing conditions are the most vulnerable to the effects of COVID-19.

Some pre-existing conditions create more significant complications on the road to recovery than others. For example, asthma, lung disease, heart disease, diabetes, and HIV are all conditions that can make fighting off the disease all the more difficult. Many American seniors have at least one pre-existing condition. With the greatest risk of complications falling on the shoulders of the senior community, the Centers for Medicare and Medicaid Services (CMS) modified Medicare’s coverage in response to the COVID-19 pandemic.

How Medicare covers testing for COVID-19

About three months after the first COVID-19 case was reported in China, Medicare announced that the coronavirus test would be covered by Medicare Part B. A six-inch cotton swab is placed in your nose and moved around to obtain a test sample. This sample gets sent to a lab which will then confirm your diagnosis.

Medicare normally covers Part B services at 80%, leaving you with a 20% coinsurance. However, currently, Part B is covering 100% of the coronavirus test. Medicare Part B also covers a COVID-19 antibody test. The antibody test confirms whether you have developed immunity to COVID-19. Unlike the diagnosis test, Medicare covers an at-home version of the COVID-19 antibody test.

How Medicare covers treatment for COVID-19

Because SARS-CoV-2 is a novel coronavirus, therapies proven to treat COVID-19 don’t exist yet. However, researchers and doctors all over the world are working hard to come up with an effective treatment plan. With that said, Medicare covers any medically-necessary service, such as hospitalization if you get COVID-19.

In addition to developing a treatment plan, medical scientists are trying to formulate a vaccine. Medicare covers some vaccines under Part B and others under Part D. Medicare states that if a COVID-19 vaccine is created, Part D will cover it, and every Part D plan is required to include it on its drug formulary.

Woman consulting physician through telemedicine
Woman consulting physician through telemedicine photo by csp_rocketclips

Medicare and telemedicine during the COVID-19 pandemic

Telemedicine is the modern-day version of doctor visits. Telemedicine, or telehealth, refers to a medical service, such as a doctor's appointment, performed by video chat. These visits with your doctor mean that you can visit with your doctor while staying at home and avoiding the virus.

Up until the pandemic, Medicare only covered telemedicine services under specific circumstances. There were many requirements both the patient and doctor had to meet for Medicare to cover telemedicine services properly. However, because its beneficiaries should stay home to lessen their exposure to the virus, Medicare broadened its telemedicine coverage.

Now, Medicare covers telemedicine doctor visits for any of its beneficiaries regardless of their location. However, not all medical providers are currently offering telemedicine services to their patients. If your doctor provides telemedicine appointments, take advantage of them. While they are allowed to charge you for your visit, many providers are waiving these fees amid the pandemic.

How seniors can stay safe during the COVID-19 pandemic

If you’re a senior with or without pre-existing conditions, you should limit your exposure. If you have prescriptions that need refilling, request a 90-day supply to be covered by your Part D plan, so you don’t have to return to the pharmacy again for a while. Instead of grocery shopping inside, use your local store’s curbside pick-up or delivery services.

If you must go out, protect yourself with a mask, a fresh pair of washable or throwaway gloves, and social distance. While you can’t remain at home forever, you can take sensible precautions during the outbreak to better your chances of not becoming infected with COVID-19. But know, if you do, Medicare has your back.


About Danielle Roberts, Contributing Author

Danielle is a Medicare insurance expert, National Social Security Certificate Holder, the co-owner of Boomer Benefits, and a frequent speaker for both agent and consumer groups. She writes for and is cited by several major online publications, including Forbes.com, has conducted seminars and webinars about Medicare that have educated thousands, and regularly appears as a guest expert on healthcare podcasts and radio shows. A TCU journalism graduate and former magazine editor, she enjoys sharing her knowledge about Medicare, retirement, and insurance so that baby boomers can prepare for the costs of healthcare in retirement.

Outside of work, she is an avid outdoor enthusiast, pursuing activities such as hiking, boating, snow skiing, whitewater rafting and recreational water sports. She is married and lives in Fort Worth with her husband and 2 children of the furry kind.

For more information visit Danielle's blog at https://daniellekroberts.com/

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