Medicare and COVID-19: What You Need to Know

What first started as a cluster of pneumonia cases in China in December 2019 has been declared a pandemic by the World Health Organization (WHO). The highly-contagious infection, known as COVID-19, quickly spread to countries around the world.

Available data shows that the virus is more severe in seniors and in people with chronic medical conditions, especially if they are immunocompromised or have underlying conditions like diabetes, heart disease, or lung diseases like COPD. To get ahead of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has taken action to protect its beneficiaries. This is what you need to know.

The Impact of COVID-19 on Medicare Beneficiaries

COVID-19 has taken its toll on the Medicare community. Between January 1 and February 20, 2021, more than 3.86 million Medicare beneficiaries were diagnosed with the infection. On average, there were 6,144 cases for every 100,000 Medicare beneficiaries. American Indians and Alaskan Natives were most effected at a rate of 9.490 per 100,000 people followed by Hispanics at 8,413 and Blacks at 7,626. The lowest rates were for Asian/Pacific Islanders at 4,235 per 100,000 people and Whites at 5,770 per 100,000 people.

When it comes to pre-existing conditions, rates were higher for Medicare beneficiaries who had anemia, diabetes, hyperlipidemia, hypertension, or kidney disease. The highest rate (14,014 per 100,000) was reported for those who had end-stage renal disease (kidney disease requiring dialysis).

Of those infected, more than 1,058,736 people were hospitalized, averaging 1,694 hospitalizations per 100,000 people. Those hospitalizations have cost $15.5 billion for people on traditional Medicare or about $24,600 per patient.

Coronavirus Testing

If you have symptoms or are otherwise at risk for COVID-19 (e.g., you have been in contact with someone who has the disease), Medicare will cover your test free of charge. You will not have to pay a copay.

Keep in mind the test will not be performed unless it is ordered by a medical professional.

If you have symptoms and think you may be sick with COVID-19, you can use our printable Doctor Discussion Guide below to help prepare you for talking with your healthcare team about getting a diagnosis.

Telehealth and Telemedicine

Getting sick during a pandemic can be anxiety-provoking. If you develop symptoms, you will want to be evaluated to assure you are not infected and to get the care you need when you need it. Some people may have chronic illnesses or transportation issues that make it difficult to get to an emergency room, urgent care clinic, or doctor’s office. In addition, it could be risky to go into a waiting room full of people where you could spread the disease to others or vice versa.

This is where telehealth, also known as telemedicine, can help. These types of visits allow health professionals and patients to speak to each other in real-time using video conferencing. This can be done online or via mobile apps using HIPAA-compliant healthcare software.

Medicare Advantage plans were allowed to add telehealth as an optional supplemental benefit in 2019. Original Medicare also covers telehealth visits but limits who can use it. The service is available to people who live in qualifying rural areas and who are located at designated medical sites (i.e., visits are not covered from home), people who require stroke evaluations regardless of their location, and people who have end-stage renal disease and receive dialysis treatment at home.

Even without this expanded coverage, a telehealth visit usually costs less than an in-office visit. The goal is to keep you at home whenever possible to decrease the risk of being exposed to COVID-19 in the community.

Hospitals and Skilled Nursing Facilities

People who live in rural areas may not live close to healthcare facilities. The Medicare Rural Hospital Flexibility Program helped to increase access to care by allowing certified critical access hospitals (CAHs) to open in those areas of need. These hospitals are smaller in scale than traditional hospitals but are required to have emergency rooms. A CAH is limited to having 25 inpatient beds and is not permitted to have hospital stays longer than 96 hours. In response to the COVID-19 pandemic, however, CMS has waived restrictions on CAHs so they can house more patients and lengthen their stays as needed.

Medicare will continue to pay for medically-necessary stays in a traditional hospital as well. That being the case, the two-midnight rule still applies. This means that you will be placed under observation (where Part B covers your stay) or admitted as an inpatient (where Part A covers your stay) based on how sick you are, the intensity services you receive, and how long you are expected to stay in the hospital.

Traditionally, Medicare requires you to have an inpatient hospital stay that lasts at least three days before it will cover a stay in a skilled nursing facility (SNF) or nursing home. Medicare Advantage plans have had the option to waive that rule but CMS is now allowing Original Medicare to waive that rule as well. If there are increases in COVID-19 cases, hospitals may reach peak capacity. In order to care for the sickest people, some patients may need to be diverted to other locations—including CAHs or SNFs—as they recover or are treated for less serious conditions.

Precautionary On-Site Restrictions

CMS has taken precautions to protect you when you stay in a skilled nursing facility. Fewer people will be allowed on the premises and there will be fewer interactions between the residents. That means there are restrictions on volunteers and non-essential employees, restrictions on visitors unless someone is at the end-of-life, and restrictions on group activities and communal dining. Social distancing can be difficult to achieve in such close quarters but every effort needs to be taken to decrease the risk of exposure to this contagious virus.

Emergency Use Authorizations

Several treatments have been granted emergency use authorization (EUA) by the FDA. These treatments are approved in the short-term based on preliminary data. They have not yet completed the full FDA approval process. It is possible these treatments could be denied approved at a future date once all trials have been completed and the data reviewed.

With safety in mind, Medicare does not traditionally cover medications that have not completed the full FDA approval process. However, COVID-19 poses an increased risk for Medicare beneficiaries in particular. For that reason, the Centers for Medicare & Medicaid Services added a rule that allowed coverage for treatments with emergency use authorizations, including vaccines and other therapeutics when it came to COVID-19.

At the present time, all COVID-19 vaccinations with an EUA are free to Medicare beneficiaries without any cost sharing, i.e., no copays or deductibles.

A Word from Verywell

Seniors and people with chronic conditions are at greater risk for developing severe respiratory complications from COVID-19. With that in mind, CMS has taken action to increase Medicare coverage and improve access to services that can help diagnose and treat the condition.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.