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How Do Different Parts of Medicare Cover Coronavirus (COVID-19) Treatment Costs?

Christian Worstell

by Christian Worstell | Published October 08, 2020 | Reviewed by John Krahnert

Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.

While there is no cure for COVID-19 or vaccine for the novel coronavirus, there are effective treatments for many of the disease’s symptoms.

How much can a Medicare beneficiary expect to pay for COVID-19 treatment? Let’s break it down based on the various types of Medicare coverage.

How is COVID-19 treated? 

To investigate the type of expenses that a Medicare beneficiary may incur as a result of a COVID-19 infection, we’ll examine how different types of Medicare coverage might be involved in treatment steps such as:

  • Seeing a doctor because of symptoms
  • Getting a referral from your doctor for a COVID-19 test and undergoing the test
  • Being admitted to the hospital
  • Taking medications

Original Medicare and coronavirus costs

Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance).

To illustrate how Original Medicare might pay for COVID-19 testing and treatment, we’ll use a hypothetical example of a Medicare beneficiary named “John.” John has Medicare Part A and Part B, but no other supplementary insurance. 

  • John comes down with symptoms similar to COVID-19 infection and schedules an appointment to see his doctor (who accepts Medicare).

    The appointment is covered under Medicare Part B, but John is first responsible for meeting his annual Part B deductible, which is $198 in 2020.

    If the cost of the appointment is greater than $198, or if John already met his Part B deductible earlier in the year, he will typically pay a 20% coinsurance for the remaining costs. 

  • John is examined by his doctor, who refers John to be tested for COVID-19. John then visits a testing facility where he tests positive for the disease.

    Because Medicare covers the COVID-19 test in full, John owes nothing out-of-pocket for the test.

    Although the COVID-19 test is covered in full by Medicare, you must get a doctor’s referral for the test in most states. Receiving a referral requires making a doctor’s appointment, which in turn requires you to meet the Part B deductible and pay any applicable coinsurance. 

  • After testing positive, John returns home to recuperate. He takes some over-the-counter aspirin for his fever, he takes over-the-counter asthma medication to open up his breathing and he takes over-the-counter cough medicine (fever, cough and shortness of breath are the three main symptoms of COVID-19).

    Over-the-counter drugs are not covered by Medicare, so John must pay out of pocket for these drugs.

  • After a few days, John’s condition is worsening so he visits the emergency room. If he met his Part B deductible, John’s now most likely responsible for a 20% coinsurance payment for the cost of the emergency room visit. 

  • John is examined in the ER by a doctor and admitted to the hospital as an inpatient.

    Upon admission to the hospital, John begins a benefit period where he is responsible for meeting a $1,408 deductible (in 2020) before Medicare Part A starts paying its share of his inpatient hospital costs.

    Once he meets that deductible, he does not owe any Part A coinsurance amount, unless his stay lasts longer than 60 days. John spends a week at the hospital receiving treatment and is sent home to finish his recovery. 

  • Upon discharge from the hospital, John is prescribed medication to further help with his cough and breathing. Original Medicare does not cover prescription drugs taken outside of the hospital, so John must pay for his drugs out of his own pocket.

John eventually recovers from the disease, but he faced a few costs along the way. Here is a breakdown of John’s total out-of-pocket Medicare spending:

  • Medicare Part B deductible ($198 in 2020)
  • Medicare Part A deductible ($1,408 per benefit period in 2020)
  • 20% of the cost of his emergency room visit
  • 100% of the cost of his over-the-counter (OTC) drugs
  • 100% of the cost of his prescription drugs

All told, John is likely responsible for at least $1,606 for his doctor’s appointment and hospital admission alone. On top of that, he’ll be responsible for 20% of his emergency room visit and all costs of his medications.

In this hypothetical example, it’s likely that John’s coronavirus infection will cost him around $2,000 or more.

Medicare Advantage plans and Part D prescription drug plans and COVID-19 costs

Medicare Advantage plans (Medicare Part C) are sold by private insurance companies and are required by law to provide all of the same benefits as Medicare Part A and Part B.

Where Medicare Advantage plans differentiate themselves is with the extra benefits some plans may offer, such as coverage for dental, vision, hearing, transportation and more. Most Medicare Advantage plans include prescription drug coverage.

Medicare Part D plans provide coverage exclusively for prescription medications and can be used alongside Original Medicare. 

Let’s examine another hypothetical example.

“Tom” has Original Medicare and a Medicare Part D prescription drug plan. 

  • Tom’s COVID-19 experience is very similar to John’s, as outlined above. Tom is responsible for paying the Part A and B deductibles and Part B coinsurance for the emergency room visit.

  • Tom’s Medicare Part D plan, provides coverage of the drug that he was prescribed to help with this breathing. His Part D plan does not, however, cover the cost of over-the-counter drugs.

Here is a breakdown of some of Tom’s out-of-pocket Medicare costs for coronavirus treatment:

  • Medicare Part B deductible ($198)
  • Medicare Part A deductible ($1,408)
  • 20% of the cost of his emergency room visit
  • 100% of the cost of his over-the-counter drugs

Tom may have to meet a small deductible for his prescription drugs, and may even have a copayment requirement. The amount of his Part D deductible and copay costs will vary, depending on the plan he has.

Tom can, however, expect to pay for slightly fewer out-of-pocket expenses for his COVID-19 experience than John, since he has a Part D plan that covers his prescribed medication.

Now let’s consider a hypothetical example involving “Karen,” who has a Medicare Advantage plan that includes prescription drug coverage. For this example, Karen undergoes the same coronavirus infection treatment as Tom and John in the examples above.

  • Karen is responsible for paying the Part A and B deductibles and Part B coinsurance for her ER visit (some Medicare Advantage plans are waiving these costs amid the COVID-19 outbreak).

  • Karen’s Medicare Advantage plan not only covers prescription drugs but also includes benefits for over-the-counter drugs (some Medicare Advantage plans offer allowances for certain OTC medicines and supplies).

 Here is a breakdown of Karen’s total out-of-pocket spending:

  • Medicare Part B deductible ($198)
  • Medicare Part A deductible ($1,408)
  • 20% of the cost of her emergency room visit

Like Tom, Karen may also have to meet a small deductible and minor copayments for her prescription drugs.

But while Tom must pay for his over-the-counter drugs in full, Karen has some coverage through her Medicare Advantage plan. Karen can expect to pay slightly less than Tom (and significantly less than John) for her COVID-19 experience. 

Medicare Supplement Insurance (Medigap) and COVID-19 costs

Medigap, or Medicare Supplement Insurance, is a supplementary form of coverage that is used alongside Medicare Part A and Part B.

Medigap plans can help cover the cost of certain out-of-pocket Medicare costs like deductibles, copayments and coinsurance. 

Medicare Supplement plans and Medicare Advantage plans are not the same thing. You cannot have both Medicare Supplement Insurance and a Medicare Advantage plan at the same time.

Let’s consider another hypothetical example, this time using “Jane” to illustrate how Medigap plans can help cover Medicare costs. In this example, Jane has Original Medicare and Medigap Plan F, which covers more costs than any other type of standardized Medigap plan. 

  • Jane’s Medigap plan provides full coverage of the Medicare Part B deductible and coinsurance, so she pays nothing out of pocket for her initial trip to the doctor.

  • Jane spends a few days at home taking over-the-counter drugs. Her Medigap plan doesn’t cover any prescription or over-the-counter drugs, so she must pay for these entirely out of pocket.

    Standardized Medigap plans don’t cover prescription drugs. 

  • Jane visits the emergency room as her symptoms worsen. Because her Medigap plan covers the Part B coinsurance in full, she pays nothing for the visit.

  • Her Medigap plan also provides full coverage of the Part A deductible, which means she pays nothing for her hospital stay when she is admitted for inpatient care.

  • Upon discharge, Jane must pay out of pocket for her prescription drugs. 

Here is a breakdown of Jane’s total out-of-pocket spending:

  • 100% of the cost of her over-the-counter drugs
  • 100% of the cost of her prescription drugs

Because Jane incurred no charges for her doctor appointment, emergency room visit or hospital stay, her bout with COVID-19 cost her far less in out-of-pocket Medicare costs than John, Tom or Nancy paid.

It should be noted that Jane still is responsible for paying her monthly Medigap plan premium. Some Medicare Advantage plans, even most plans with prescription drug coverage, charge $0 monthly premiums.

Paying for COVID-19 treatment if you have Original Medicare, a Part D plan and Medigap

Let’s consider one final hypothetical example. Let’s imagine “Bill” has Original Medicare, a Medicare Part D plan and Medigap Plan F. Let’s also imagine that his coronavirus infection treatments are the same as for the examples provided above.

  • Like Jane, Bill’s Medigap plan provides full coverage of the Medicare Part B deductible and coinsurance, so he pays nothing out of pocket for his doctor’s office visit when he first exhibits symptoms of COVID-19.

  • Bill is admitted for inpatient hospital care due to his COVID-19 infection. His Medigap plan pays for his Part A deductible, Part A coinsurance and any additional Part B copay/coinsurance costs during his inpatient hospital stay.

  • Bill is discharged after recovering, and he is prescribed medication to help him continue recovery. Because Bill has a Part D plan, he does not have to pay for his prescription drugs in full out of his own pocket. Bill simply pays a small deductible and minor copayments for drugs covered by his Part D plan.

  • Not all Part D plans offer over-the-counter benefits, so Bill will typically still have to pay out-of-pocket for those.

Here is a breakdown of Bill’s total out-of-pocket spending:

  • 100% of the cost of his over-the-counter drugs

Bill paid the least out of pocket for his COVID-19 treatment out of any of our examples above. Again, however, it should be noted that Bill pays monthly premiums for his Part D plan, his Medigap plan and for Medicare Part B.

Find the right Medicare coverage for you

Medicare beneficiaries can have very different experiences with COVID-19 treatment costs, based on the type of Medicare coverage they have.

Is the COVID-19 pandemic making you rethink your Medicare coverage strategy? You can call today to speak with a licensed insurance agent who can help you compare Medicare Supplement plans available where you live.

Find Medigap plans in your area.

Find a plan
Or call 1-800-995-4219 to speak with a licensed insurance agent.

 

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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