Treatment costs related to COVID-19 vary depending on its severity and how much you need to access healthcare services. Medicare beneficiaries who contract COVID-19 are at higher risk for severe illness and may require hospitalization due to increased age and the likelihood of having underlying health conditions. Medicare COVID-19 coverage helps with hospital and outpatient treatments. Your costs depend on what type of Medicare insurance you have.
|1. Medicare treatment costs for COVID-19 vary depending on how much care you need, and which type of Medicare insurance plan you have. Medicare beneficiaries are at higher risk for severe COVID-19 infection.||2. COVID-19, a viral illness for which there is no cure, is treated primarily by managing symptoms and boosting the body’s ability to fight it effectively.|
|3. If you need to access your healthcare benefits and only have Original Medicare, COVID-19 treatment costs include Part A and B deductibles, copays and coinsurance for services, and all medication costs. There is no set out-of-pocket maximum amount.||4. If you need to access your healthcare benefits and have a Medicare Advantage Plan (Part C) with drug coverage, or a supplement insurance (Medigap) and drug coverage (Part D), COVID-19 treatment and medication costs will vary, but may include premiums, copays and coinsurance. There is a set out-of-pocket maximum amount with these plans which are offered by Medicare-approved private insurance companies.|
Medicare pays for COVID-19 treatments in much the same way as any other health concern. This includes coverage for medically necessary care including:
There are out-of-pocket costs associated with these services in the form of premiums, deductibles, copays, and coinsurance. In the case of COVID-19, because it is a public health emergency, Medicare is waiving some costs. For instance, COVID-19 tests are free, as are some telehealth visits to help evaluate and manage your condition without you having to leave your home.
In general, if you access health care while you have COVID-19, more care can mean more cost to you. In a worst-case scenario where you have an extended inpatient stay and ongoing complications, Medicare Advantage plans with an out-of-pocket maximum, or supplemental insurance (Medigap) that covers some deductibles and copays will be most economical. In a best-case scenario, if you contract COVID-19 and can effectively manage your symptoms at home, your primary cost will be for over-the-counter medications.
COVID-19 treatment is aimed at lessening the severity of the illness, managing symptoms, and preventing complications, especially for those who are at risk for disease progression due to underlying health conditions. Treatment options include:
If you only have Original Medicare, without supplemental or drug coverage, you will have to pay deductibles, copays, and coinsurance for services, and for all OTC and prescription medications. That’s in addition to the monthly premium of $148.50 for Part B. There is no maximum out-of-pocket dollar amount with Original Medicare.
Medicare covers all medically necessary hospitalizations. If you require hospitalization, under Medicare Part A, you pay a $1,484 deductible for each benefit period, plus Part B coinsurance of 20% for doctors’ services during your stay. A benefit period begins the day you are admitted and ends when you haven’t gotten any inpatient care for 60 days in a row. If your stay is longer than 60 days, you’ll pay $371 coinsurance per day for the next benefit period. You pay higher coinsurance per day for subsequent benefit periods and have limited lifetime reserve days.
If you need to stay in quarantine, but would otherwise be discharged from your inpatient stay, you are still covered under Part A. Drugs and treatments given to you in the hospital are covered under Part A.
If you receive COVID-19 medical care in an outpatient setting, including emergency or urgent care, you will pay 20% of covered services from Part B, after you meet your $203 annual deductible.
As long as you are treated by a Medicare provider, Part B pays for monoclonal antibody treatment, if you test positive for COVID-19 and have a mild to moderate case, and if you are at high risk of needing to be hospitalized and/or at high risk of progressing to a severe or critical case.
Consider this example of COVID-19 treatment costs if you only have Original Medicare:
If you have a Medicare Advantage Plan, you have access to the same benefits as Original Medicare, including free COVID-19 lab tests. Many plans offer additional telehealth benefits, are waiving some prior authorization requirements for medications, and are allowing for services and care from providers who may be out of network. Check with your plan about your coverage and costs, and special allowances.
Medicare Advantage Plans vary in terms of coverage, premiums, deductibles and copays/coinsurance costs. In most cases, if you have a Medicare Advantage Plan and need to go to the hospital for your COVID-19 treatment, you will have a daily copay for the first part of your stay. You may also have copays for doctors’ visits while inpatient, and as an outpatient, including emergency or urgent care.
You may have to meet a deductible before your insurance starts paying, depending on your plan. Total costs and out-of-pocket maximums are lower if you receive services in the network. There is an in-network maximum out-of-pocket dollar amount established by Medicare of $7,550 for 2021, although your plan’s limit might be less.
Most Medicare Advantage Plans include drug coverage, which may come with a monthly premium, annual deductible, and copays based on what is on the plan’s formulary and whether or not the pharmacy is in network.
Consider this example of COVID-19 treatment costs if you have a Medicare Advantage Plan:
If you purchase Part D because you do not have drug coverage, you will pay a monthly premium, your dispensed drug costs, plus a deductible, depending on which plan you select. Medications from the plan’s formulary and in network pharmacies keep costs as low as possible. Some Part D drug plans are waiving or relaxing prior authorization requirements during the COVID-19 public health emergency. Prescribed medications are covered according to your Part D plan. OTC medications are not covered.
Medigap policies pay most of the costs Original Medicare doesn’t cover, such as deductibles and coinsurance, plus some other costs. There are 10 standardized Medigap plans to choose from, but not all plans are offered in all states, and not all plans are available to every Medicare beneficiary. Six of these plans cover your part A deductible at 100%, only two pay for your part B deductible, and all of them pay for Part A coinsurance and hospital costs. Most pay for all or at least a percentage of Part B copays/coinsurance.
If you have a comprehensive Medigap plan that covers the Part A deductible and Part B coinsurance, your costs for COVID-19 treatments will include your monthly Medigap policy premium and your OTC medications. If you have a Medigap policy, you will still need drug coverage, so you will have premium and co-pays for that as well.
LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.
Moore holds a bachelor’s degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.
He’s passionate about educating, informing, and resolving issues concerning Medicare and Medicare Advantage Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.