Older Americans are at a high risk for serious illness from the novel coronavirus, and most who are over age 65 are covered by Medicare.
Medicare already covers its enrollees for much of what they might need if they contract the virus and become seriously ill — and it has expanded some services and loosened some rules in response to the crisis.
Here’s a look at what enrollees can expect.
Will Medicare cover a test for the coronavirus?
Tests for the coronavirus ordered by a health care provider who accepts Medicare are covered under Part B (outpatient services). This is the case if you are enrolled in traditional Medicare or Medicare Advantage. Co-pay and deductible amounts for the test have been waived, along with associated services such as physician visits or hospital observation.
Will Medicare cover care for Covid-19, the disease the virus can cause?
Any needed outpatient services will be covered under Part B, and if you require hospitalization, it will be covered under the usual Medicare Part A rules. This includes a deductible of $1,408 for each stay, and daily co-payments if your stay exceeds 60 days. The most popular supplemental insurance policies used in traditional Medicare cover 100 percent of that, but six million enrollees have no supplemental insurance, according to the Kaiser Family Foundation.
For Medicare Advantage enrollees, the out-of-pocket costs for hospitalizations vary by plan and length of stay. Kaiser research found that for stays of five days or more, at least half of Advantage enrollees would pay more than the deductible paid by traditional Medicare enrollees without supplemental coverage.
Would Medicare cover a Covid-19 vaccine if one became available?
Medicare Part B already covers some vaccines for things like flu. If a vaccine for Covid-19 becomes available, the Centers for Medicare and Medicaid Services, known as C.M.S., has stated that it would be covered under Part D prescription drug plans, including both stand-alone plans and Medicare Advantage plans that cover drugs.
I’m in a Medicare plan that has network restrictions on the health care providers I can use. Are these limitations still in place during the crisis?
Medicare Advantage plans, and many Part D plans, typically require enrollees to use in-network providers, or pay more if they go out of network. But when a state of emergency is declared, things change.
C.M.S. has advised Advantage plans that during the crisis, they must cover services at out-of-network facilities that participate in Medicare and charge enrollees affected by the emergency no more than in-network rates.
Drug plans often require enrollees to use preferred retail or mail-order pharmacy networks. During the crisis, C.M.S. is permitting plans to relax these restrictions — but this is not a requirement, so check with your plan.
I lost my job and need to sign up for Medicare. What should I do?
People who work past age 65 can delay Medicare enrollment if they have health insurance through their employers without incurring steep penalties for late enrollment in Part B (10 percent lifetime for each 12-month period past the otherwise-mandatory sign-up age of 65).
If you were in this situation and need to sign up for Medicare now because of a job loss, you can take advantage of a special enrollment period that is available to you up to eight months after you lose coverage from employment.