Medicare coverage and coronavirus: What you should know

We understand that the rapidly evolving situation with the new coronavirus, COVID-19, can be unnerving. Since the risks associated with this disease are greatest for those over age 60, you may be especially concerned about your medical benefits. If you are enrolled in Medicare, it’s important to know that both traditional Medicare (Parts A and B) and Medicare Advantage plans will cover costs related to diagnosis and treatment of the coronavirus.

What’s covered

• Medicare Part B covers lab tests for the coronavirus. You pay no out-of-pocket costs.
• Medicare Part A covers all medically necessary hospitalizations. This includes if you're diagnosed with the coronavirus and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine. You pay your usual Medicare coinsurance and deductible for these services.
• If you’re enrolled in the Medicare Supplement Plan through the Board of Pensions, once you’ve paid the annual plan deductible, this coverage pays 80 percent of remaining allowable charges after Medicare pays its share.
• All Medicare Prescription Drug Plans (Part D) will cover a vaccine for the coronavirus if one becomes available. At this time, there's no vaccine for the coronavirus.
• If you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive deductibles, copays, and coinsurance for coronavirus lab tests. Many plans offer additional telehealth benefits beyond what Medicare covers (see below). Check with your plan about your coverage and costs.

Telehealth and virtual services

If you are concerned about being sick, Medicare covers virtual check-ins so you can communicate with your doctor by phone or video, or even an online patient portal, to see whether you need to come in for a visit. This offers you an easy way to connect with your doctor yet stay at home and avoid exposure to others. You pay your usual Medicare deductible and coinsurance for these services.

• Virtual check-ins allow you to talk to your doctor or certain other practitioners, including nurse practitioners or physician assistants, using a device such as your phone, integrated audio/video system, or captured video image, without going to the doctor’s office.
• You must have an established relationship with your doctor or other practitioner.
• You must talk to your doctor or other practitioner to start these types of visits.
• The communication must not be related to a medical visit within the past seven days and must not lead to a medical visit within the next 24 hours (or the soonest appointment available).
• You must consent verbally to using virtual check-ins and your doctor must document that consent in your medical record before you use this service. You pay your usual Medicare coinsurance and deductible for these services.
• Medicare also pays for you to communicate with your doctors using an online patient portal, without going to the doctor’s office. This is known as an e-visit. As with virtual check-ins, you must initiate e-visits.
• If you live in a rural area, you may have full visits with your doctors through telehealth. The law requires that these visits take place at specified sites of service, known as telehealth originating sites, using a real-time audio and video communication system at the site to communicate with a remotely located doctor or certain other types of practitioners. Medicare pays for many medical visits through this telehealth benefit.

The safety and well-being of our members is a top priority for the Board. With new information coming to light daily, and even hourly, we are monitoring real-time developments and looking to experts such as the Centers for Disease Control (CDC) and the World Health Organization (WHO) for guidance. You can find helpful resources on our website.