COVID-19 is an infectious illness with no known treatment, while numerous therapies and vaccines have been produced or are under development. COVID-19 is diagnosed by testing, and the severity of the sickness determines therapy. at home tests are available through many different venues.

Seniors are at increased risk of becoming critically ill if infected with SARS-CoV-2, the coronavirus that causes COVID-19, due to their older age and a higher chance of having major medical problems than younger ones. According to the Centre for Medicare & Medicaid Services (CMS) statistics, around 2,129 per 100,000 cases of COVID-19 among the 65 and above Medicare members since the outbreak have been reported. 

So are you eligible to get to receive at home Covid test?  You can find all the information in this guide.

Medicare Part B Beneficiaries above the Age of Sixty-Five Qualifies For At Home Covid Test

Medicare covers more than 60 million people aged 65 and above and younger folks with long-term impairments. However, the government has announced that Medicare part B members above the age of 65 would be eligible for up to 8 home covid-19 tests every month. This policy has been initiated to provide premium medical assistance to the elderly citizens of the US who falls under the coverage of Medicare Part B. 

If you are unsure about the benefits of Medicare Part B and who qualifies for the OTC Covid tests, this blog post details everything you must know about in a detailed manner!

Does Medicare Cover COVID-19 Testing?

The Biden Administration announced an effort in April 2022 that provides Medicare coverage for up to eight at home COVID tests each month for Medicare Part B participants, including those on conventional Medicare and Medicare Advantage. Medicare beneficiaries can obtain the tests at no cost from qualifying pharmacies and other entities such as Medcare under this new effort; they do not need to pay for the tests and file for reimbursement. Medicare Advantage plans can also pay for at-home Covid examinations, although this is not mandatory.

Part B of Medicare covers diagnostic lab testing for COVID-19. Every time a health practitioner or doctor orders clinical diagnostic laboratory tests, Medicare pays for them. According to updated guidelines finalized on September 2, 2020, a beneficiary may get Medicare coverage for one COVID-19 and associated test without the permission of a physician or other health practitioner. However, any subsequent COVID-19 testing requires a physician’s demand.

Medicare also covers serology testing (antibody tests), which can establish if a person has been infected with SARS-CoV-2, the virus that causes COVID-19, and has produced antibodies to the virus. Medicare Advantage plans must cover all Medicare Part and Part B services, including COVID-19 lab testing.

What Is The Cost Of COVID-19 Testing For Medicare Beneficiaries?

• During the COVID-19 public health emergency, Medicare beneficiaries can acquire the tests at no cost through qualifying pharmacies and other businesses under the Biden Administration’s program for Medicare to pay the cost of up to 8 OTC COVID tests each month for Medicare beneficiaries with Part B.

• Beneficiaries can also receive free at-home testing through community venues such as health centers and rural clinics. They can also request four free at home Covid tests through a federal government website, according to previous moves announced by the Biden Administration in December 2021.

• Since clinical diagnostic laboratory tests are covered at no cost sharing under conventional Medicare, Medicare beneficiaries who undergo a lab test for COVID-19 are not required to pay the Part B deductible or any coinsurance for this test. Beneficiaries will also not be required to pay for the COVID-19 serology test as it is considered a diagnostic laboratory test. (Under conventional Medicare, recipients usually have a $233 deductible and 20% coinsurance for Part B treatments.)

• Beneficiary cost sharing for COVID-19 testing-related services, including the accompanying physician appointment or another outpatient visit, is likewise eliminated under the Families First Coronavirus Response Act (such as hospital observation, E-visit, or emergency department services). A testing-related service is a medical visit provided during an emergency that culminates in the ordering or administration of a test.

• The bill also forbids the use of prior authorization or other user management requirements for the COVID-19 test and testing-related services for Medicare Advantage members and the use of prior authorization or other utilization management requirements for these services.

Does Medicare Cover COVID-19 therapy?

Patients who get critically ill due to the virus may require a variety of inpatient and outpatient care.

Part A

Part A of Medicare covers inpatient hospitalization, skilled nursing facility (SNF) stays, home health visits, and hospice care. If inpatient hospitalization is necessary for COVID-19 therapy, Medicare beneficiaries, including those on conventional Medicare and Medicare Advantage plans, will be covered.

This includes treatment with therapeutics that are authorized or approved for use in COVID-19 patients hospitalized, for which hospitals are reimbursed a fixed amount that includes the cost of any medicines a patient receives during their inpatient stay and costs associated with other treatments and services. SNF stays are covered for beneficiaries who require post-acute care following a hospitalization, but Medicare does not pay for long-term treatments and supports, such as protracted stays in a nursing home.

Part B

Under Part B, Medicare covers outpatient services such as physician visits, physician-administered and infusion medicines, emergency ambulance transports, and emergency department visits. According to the program guidelines, Medicare pays for the monoclonal antibody infusion treatments that are usually given in an out-patient setting and is meant for treating mild to moderate symptoms of covid-19. However, the treatment must be approved by the FDA under Emergency Use Authorization (EUA) before the execution.

The FDA has approved two oral antiviral medicines for COVID-19 from Pfizer and Merck. Once approved by the FDA, these medicines will most likely be covered under Medicare Part D; nevertheless, the definition of a Part D covered medication excludes pharmaceuticals allowed for use by the FDA but not FDA-approved.

CMS recently published guidelines to Part D plan sponsors, including both stand-alone drug plans and Medicare Advantage prescription drug plans, that offer them flexibility and strongly encourage them to supply these oral antivirals to their participants, while this is not a mandate. In the short term, access to these treatments may be restricted due to a lack of supply, even though the federal government has acquired millions of pills and is distributing them to states.

What Is The Cost Of COVID-19 Therapy For Medicare Beneficiaries?

Beneficiaries admitted to a hospital for COVID-19 therapy in 2022 would be subject to the Medicare Part A deductible of $1,556 per coverage period. Part A also demands daily co-payments for inpatient hospital and skilled nursing facility stays. Beneficiaries would pay a $389 co-payment per day (days 61-90) and $778 per day for lifetime reserve days for lengthy hospital stays.

Though a patient is compelled to be quarantined in a hospital, even if they no longer require acute inpatient treatment and would otherwise be discharged, they are not obliged to pay an extra deductible for hospital confinement. Traditional Medicare patients who require post-acute care following a hospitalization would have $194.50 per day co-payments for long days in an SNF (days 21-100).

In 2022, there is a $233 deductible and a 20% co-pay for most outpatient treatments covered by Part B, including physician visits and emergency ambulance transportation. However, according to a new CMS program directive, Medicare beneficiaries would pay no cost sharing and no deductible for COVID-19 monoclonal antibody therapy, specifically, an infused treatment delivered in outpatient settings.

While the majority of traditional Medicare beneficiaries (90% in 2018) have supplemental coverage (such as Medigap, retiree health benefits, or Medicaid) that covers some or all of their cost-sharing requirements, 5.6 million beneficiaries did not have supplemental coverage in 2018, putting them at a higher risk of incurring high medical expenses or preceding medical care due to cost. There is no out-of-pocket maximum for services covered by Medicare Parts A and B.

Beneficiaries’ cost-sharing obligations in Medicare Advantage plans vary per plan. Inpatient hospital stays, emergency department treatments, and ambulance transportation are frequently subject to daily co-payments under Medicare Advantage plans. Medicare Advantage subscribers should anticipate paying varying amounts for a hospital stay based on the duration and the cost-sharing rates in their plan.

According to CMS guidelines, Medicare Advantage plans may waive or decrease cost sharing for COVID-19-related therapies. Most Medicare Advantage insurers temporarily reduced such expenses; however, many of those waivers have since expired. Plans may also waive prior permission requirements for COVID-19-related services.

Does Medicare Cover COVID-19 Vaccinations And Boosters, And How Much Do Beneficiaries Pay?

Certain preventative vaccinations (influenza, pneumococcal, and Hepatitis B) are covered by Medicare Part B and are not subject to coinsurance or deductible. Vaccines connected to medically essential therapy are also covered under Medicare Part B. Traditional Medicare members who require these medically essential immunizations would be subject to the Part B deductible and a 20% co-pay.

A vaccination licensed by the FDA for COVID-19 is covered by Medicare under Part B with no cost-sharing for Medicare beneficiaries for the vaccine or its administration, according to a provision in the CARES Act; this applies to beneficiaries in both conventional Medicare and Medicare Advantage plans.

Although the CARES Act expressly provided for no-cost Medicare coverage of COVID-19 vaccines licensed by the United States Food and Drug Administration (FDA), CMS has issued regulations requiring no-cost Medicare coverage of COVID-19 vaccines authorized for use under an emergency use authorization (EUA) but not yet licensed by the FDA. This policy of offering immunizations to Medicare enrollees at no cost also extends to booster doses.

So far, the FDA has approved EUAs for three COVID-19 vaccines from Pfizer-BioNTech, Moderna, and Janssen, as well as boosters for Pfizer and Moderna after a primary series of the vaccine, was completed.

Are There Any Specific Requirements For Skilled Nursing Facilities Or Nursing Home Residents?

In response to the national emergency declaration linked to the coronavirus pandemic, CMS has relaxed the requirement for a 3-day preceding hospitalization for coverage of a skilled nursing facility (SNF) for Medicare beneficiaries who need to be moved as a consequence of a catastrophe or emergency. For the beneficiaries who have got their SNF benefits exhausted recently, the CMS waiver allows them to extend their SNF coverage without starting a new benefit term.

Nursing home residents with Medicare who require inpatient hospital care or other Part A, B, or D covered services related to testing and treating coronavirus illness have the same rights as community residents with Medicare.

Medicare establishes quality and safety requirements for nursing facilities with Medicare beds and has offered guidelines to facilities to aid in the prevention of coronavirus infections. During the early months of the COVID-19 pandemic, nursing homes were instructed to limit visitors and non-essential health care personnel (except in compassionate care situations such as end-of-life), cancel communal dining and other group activities, actively screen residents and staff for COVID-19 symptoms, and use personal protective equipment (PPE).

Recently, CMS reopened recommendations and updated advice on visiting safety criteria in nursing facilities to allow indoor and outdoor visits. Nursing homes must also report COVID-19 data to the Centers for Disease Control and Prevention (CDC), including data on infections and deaths and the COVID-19 vaccine status of residents and staff, and provide information to residents and their families. They are also required to test employees on a weekly basis if they are located in states with a positivity rate of 5% or higher.

It should be noted that CMS recommendations for nursing homes and data reporting obligations do not apply to assisted living facilities controlled by states. When it comes to legislation to prevent the spread of coronavirus infections in assisted living facilities, as well as COVID-19 data reporting requirements, analysis has revealed significant diversity among states.

Now that you know everything about MedCare eligibility, stay safe and protected by getting tested every time there’s a need and play your part in keeping the society safe, secure, and protected.