As the coronavirus continues to affect people around the world, the U.S. Centers for Disease Control and Prevention (CDC) has issued guidelines for the public, from face coverings to social distancing, in an effort to keep Americans vigilant and protected. If and when you need to get tested for COVID-19 or access treatment, cost should not be a barrier. Learn how Medicare is responding to the coronavirus by streamlining access to COVID-19 testing and treatment.
About Coronavirus and COVID-19
Coronaviruses are not new. Some cause mild respiratory illnesses and colds, while others cause more serious complications and have a higher mortality rate.
The pandemic of 2020 started after a new coronavirus, identified as SARS-CoV-2, was found on December 31, 2019, in Wuhan, China. COVID-19 is the name given to the disease caused by the coronavirus. As of December 2020, it’s responsible for infecting more than 15 million people in the United States, with numbers still climbing.
How Dangerous Is the Coronavirus?
This form of coronavirus is spread from person to person predominantly through the air via particle transmission. Public health officials urge people to wear masks, avoid public spaces whenever possible, and wash hands regularly. Though many who become infected with coronavirus recover and return to life, as usual, some people can become seriously ill and require intensive treatment. As there is currently no cure for COVID-19, treatment consists of supportive medical interventions to reduce symptoms. Occasionally, complications such as respiratory failure, organ failure, and sepsis lead to death.
Are Medicare Beneficiaries at High Risk for Coronavirus?
Medicare beneficiaries who are of advanced age or disabled are at particularly high risk of contracting coronavirus. Disabled individuals whose conditions include a poor immune response or whose respiratory system is already compromised have difficulty recovering from COVID-19. Additionally, COVID-19 can negatively impact pregnancy in disabled females who have Medicare coverage. This is why it’s imperative that everyone, particularly Medicare beneficiaries, discuss any new medical concerns with their healthcare provider and get tested for COVID-19 as soon as possible.
Should I Get Tested for COVID-19?
The incubation period for COVID-19 is anywhere from two days to 14 days. As such, you can be exposed to the virus and expose other people to the virus before having any symptoms. You may not even realize that you are sick until up to two weeks after exposure. Maintain communication with your healthcare provider and utilize telehealth visits whenever possible if you are at risk for COVID-19 infection or suspect you have been exposed. The most common symptoms of COVID-19 include:
• Extreme fatigue
• Sensory loss (no taste or smell)
• Sore throat
• Body aches
• Difficulty breathing
• Chest pain
The rising cost of healthcare expenses can be a deterrent for individuals on a fixed income or rely on disability benefits to live. The healthcare community urges adults and children to get tested as soon as possible, regardless of insurance or financial status.
How Does the Coronavirus Test Work?
There are two types of diagnostic coronavirus tests to confirm active COVID-19 infection: molecular and antigen. Both tests can be performed in a laboratory setting or at designated testing sites throughout the country. Molecular tests confirm or rule out a COVID-19 diagnosis by detecting the virus’s genetic material, while antigen tests look for proteins from the virus. Take a look at how the two tests compare.
Molecular COVID-19 Tests
Highly accurate with results available as soon as the same day, the molecular COVID-19 test is conducted by taking a saliva or mucus sample from the nasal passages or throat. Usually, one test is enough to confirm an active diagnosis, and there are a few instances where it needs to be repeated. The downside to this test is that it can take up to a week to receive results in areas with high testing frequency.
Antigen COVID-19 Tests
The antigen test is conducted by obtaining a nasal swab and can provide results in as little as 15 minutes. With this type of test, there is a higher rate of false positives. So while a positive antigen test may mean you have an active COVID-19 infection, your physician may need to confirm the diagnosis by administering a molecular test.
Keep in mind that although it is possible to test for COVID-19 antibodies, an antibody test cannot be used as a standalone test to confirm active infection. The presence of antibodies only means that at some point, you were exposed to COVID-19 and still have the antibodies (what your body used to fight the infection) present in your system.
Medicare Coverage for COVID-19 Tests and Treatments
Both original Medicare (Part B) and Medicare Advantage plans cover COVID-19 testing. If you have hospital insurance through Medicare (also called Part A) only and have delayed enrollment in Part B, a COVID-19 test administered in an outpatient setting is not covered.
For most Medicare recipients who have Parts A and B or a Part C (Medicare Advantage) plan, COVID-19 testing is covered with no cost share. Here is what we know about Part B coverage for COVID-19 testing:
• Tests are covered with no cost share when received from a laboratory, physician,
pharmacy, or other approved testing site
• Medicare pays for COVID-19 tests performed at a “parking lot” testing site
• Medicare will cover additional tests needed to rule out an active COVID-19 diagnosis
• Some individuals may qualify for in-home testing, which is covered by Medicare
• Medicare covers COVID-19 antibody tests even though the results cannot be standalone
evidence of an active infection
• Medicare also covers tests for certain respiratory conditions that may aid in the diagnosis
Does Medicare Cover COVID-19 Tests and Treatments?
Like other medical conditions, COVID-19 is a valid diagnosis that providers and facilities may use to submit Medicare claims. Providers who “accept Medicare assignment” (are registered Medicare providers who accept Medicare’s terms and conditions) may provide inpatient or outpatient services, request lab work, and coordinate therapies for COVID-19 patients. Providers who accept Medicare must follow Medicare guidelines when submitting medical claims.
Will Medicare Cover a COVID-19 Vaccine?
Researchers have been hard at work on possible vaccines for COVID-19, and we’re finally starting to see viable options become available to the public. The U.S. federal government previously announced that they would make it available to Medicare recipients once a vaccine is available at no cost. This will include coverage for the vaccine itself and administration. Deductibles, co-payments, and coinsurance will not apply to Medicare patients.
Find the Best Medicare Plan for You
Whether you’re currently enrolled in Medicare or due to become eligible soon, it’s important to pick a Medicare plan that fits your needs and budget. At TrueCoverage, that’s what we help you do. If you have questions about your current coverage or are interested in alternatives to original Medicare, give us a call to talk with a friendly team member.
Read our article on COVID-19 by taking care of yourself you are taking care of all of us?