Are COVID-19 Tests Still Covered By Medicare?

Question: How does Medicare cover COVID-19 tests?

Answer: Medicare coverage for COVID-19 related issues has changed as we have moved through this pandemic. In the beginning it was about isolation and CDC protocols. The immunization process began to make us feel more comfortable with COVID-19 and being around others. We are approaching the end of the National Department of Health and Human Services declared Public Health Emergency (PHE), which is set to expire at the end of the day on May 11, 2023. This PHE expiration will end many of the other declarations and legislative actions taken during this PHE.

We have heard from many individuals whose Supplemental Nutritional Assistance Program (SNAP) emergency benefits will be reduced back to their pre-pandemic levels. For many individuals and families that reduction has already happened.

Another protection that will be ending is the continuous coverage protection. Many individuals did not realize how the Medicaid enrollment process had changed during the PHE. With the PHE end, those rule changes are returning to their previous standards. Each individual/family on Medicaid will now have to recertify to their income and assets each year in order to qualify (stay qualified) for the program. Those individuals/families who are newly applying will have to begin using an expanded Medicaid application process. That Medicaid application process will require a 30 month review of finances prior to your application date for all levels of Medicaid. The 60 month review for Long Term Medicaid will continue, as this rule was not altered.

Turning back to thinking about the PHE and Medicare changes. Centers for Medicare & Medicaid Services (CMS) waived many of the coverage rules during the PHE. Many of these also will be returning to the previous standards now that PHE is expiring. Here are some of what you will see in the coming months.

Original Medicare includes Medicare Part A and Medicare Part B. Original Medicare allows you to go to any doctor, any lab, and any hospital without prior permission or referral.

CMS will be returning back to the previous standard of Medicare Part A coverage of a Skilled Nursing Home stay only after a three day hospital stay or longer. During the PHE this three day hospital stay was waived.

The COVID vaccines will continue to be covered in full by original Medicare, much like Flu Vaccine and Pneumonia vaccines.

During the PHE, CMS covered free COVID-19 over-the-counter (OTC) test kits. Original Medicare does not usually cover OTC products and this test kit coverage will end with the end of the PHE. The test kits will still be available, but will no longer be covered by Original Medicare, so you will have to pay for these OTC test kits. Medicare Advantage plans have the option to continue to cover these test kits, so check with your insurance plan if you have a Medicare Advantage plan.

The coverage of physician ordered COVID-19 tests performed in the office or lab will continue to be covered in full by Original Medicare, with no cost share to the individual.

CMS increased coverage for Telehealth Benefits during the PHE. This expanded Telehealth Benefit will continue through 2023 and into 2024. The Telehealth Benefit allows you and your physician to use Video Technology to complete office visits, mental health counseling, preventive health screenings and other visits. These visits can take place from your home, or in a health care setting, like an adult home or skilled nursing facility.

This Telehealth Benefit will have the same cost share as a typical provider visit. In other words, this Telehealth Benefit is not paid in full through Medicare or Medicare Advantage Plans. If a physician office visit would cost $40, this Telehealth visit would cost $40.

The ending of the PHE will change many of the things we have become used to, much like in the beginning of this PHE our world changed.

If you are curious about Medicare coverage, go to the source. Call 1-800-medicare, or the website at www.medicare.gov.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email SLM@lutheran-jamestown.org.


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