Medicare and Coronavirus - Will Medicare Cover Coronavirus Tests?

Medicare and Coronavirus - A test for the new coronavirus will be covered under Medicare Part B, and some large Advantage Plan providers are waiving copays or preauthorization requirements that would be applicable for diagnostic testing.

CNBC’s recent article entitled “Medicare will cover coronavirus tests. Here’s how to get one if you think you have symptoms” says that your physician would need to order a test, if they are concerned that you have the virus.

Lab services are covered by Medicare. However, if you want a random test out of the blue, it wouldn’t be covered if there’s no medically necessary reason for it. However, given the current environment, if a doctor is concerned, they’re going to say the test is medically necessary.

The number of COVID-19 cases is being tracked and is currently climbing. The fast spread of the virus has created issues with the stock market, as concerns of a global economic slowdown increase.

While the U.S. case count is low compared to some other countries, state and local governments are getting ready for community outbreaks as the virus continues to spread.

Many people experience mild symptoms from COVID-19. However, the virus appears to take a greater toll on individuals with underlying health conditions and seniors. It is similar to the influenza virus, better known as the seasonal flu. A vaccine for COVID-19 is probably a year away, if not longer. If the flu is caught early, it can be treated with antiviral medication that may lessen the symptoms and duration of the illness. However, there isn’t that option for this coronavirus.

The Centers for Disease Control and Prevention recommended that high-risk individuals stock up on supplies (such as extra medications and groceries), maintain some space between others and yourself, wash your hands frequently and avoid crowds. If there’s an outbreak in your area, stay at home as much as you can.

If you develop any symptoms that are concerning, contact your doctor by phone for guidance. The CDC has encouraged providers to use their best judgment for who should be tested, which may depend on your symptoms or other factors, such as known exposure to an infected person.

If your doctor or other provider thinks you need testing, they’ll contact their local health department or the CDC for instructions on where you can get the test, says the National Institutes of Health. The coronavirus test may involve a swab, blood draw, or other method, based on where the test is administered. The CDC said that coronavirus testing is now available across all 50 states, and Quest Diagnostics and LabCorp — two of the country’s largest private labs — are making test kits available.

Medicare Part B covers diagnostic tests. However, some of Medicare’s 62 million beneficiaries — the majority of whom are over 65 — may have a copay, if they have an Advantage Plan. Those plans may differ from original Medicare as to the amount patients must pay for any particular service. However, the good news is that many providers are waiving any cost-sharing associated with getting a COVID-19 test, as well as any prior authorizations that normally would be required, if a test is deemed warranted.

If there is a doctor’s appointment involved, you could have a copay or coinsurance, depending on your specific Medicare coverage. Costs beyond that would depend on whether you have the virus, whether you need additional medical treatment, or should self-quarantine.

Reference:  CNBC (March 10, 2020) “Medicare will cover coronavirus tests. Here’s how to get one if you think you have symptoms”