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Medicare Will Now Cover Coronavirus Tests

Christian Worstell by Christian Worstell    |    Published Mar 25, 2020

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

Vice President Mike Pence announced during a March 4 press briefing that the test for COVID-19 (coronavirus) will be covered by Medicare and Medicaid, in addition to private insurance.

The U.S. Department of Health and Human Services (HHS) assigned testing for coronavirus as an essential health benefit. And under the Affordable Care Act (ACA), health insurance plans are required by law to provide coverage for essential health benefits. 

As an essential health benefit, the test must also be covered by Medicare and Medicaid. 

“HHS has already denominated a test for the coronavirus to be an essential health benefit, which ensures that it will be covered by people’s private health insurance. It will be covered by Medicare and Medicaid,” Pence said during the briefing.

When does Medicare pay for coronavirus tests?

A coronavirus test will be covered by Medicare Part B when ordered by a doctor or health care provider. As a clinical diagnostic laboratory test, beneficiaries should expect to pay nothing for the test. 

Medicare Advantage plans (Medicare Part C) are required by law to offer the same benefits as Original Medicare, so Medicare Advantage plan beneficiaries will also receive Medicare coverage of coronavirus tests. 

Unlike other mandated diagnostic tests such as mammograms, testing for coronavirus may require patient cost-sharing for those with private (non-Medicare) health insurance plans. 

Coronavirus spreading in the U.S.

As of the time of Pence’s announcement, there were at least 138 cases of COVID-19, the disease caused by coronavirus, across 13 U.S. states. That total included 11 deaths. More than 1,200 people in the U.S. have been tested for coronavirus. 

Medicare’s coverage of the test will be instrumental in fighting the disease, as the death rate for coronavirus has thus far been significantly higher among older adults. Medicare eligibility begins at age 65 and is also available to those under age 65 who have a qualifying disability. 

Just days before Pence’s announcement, Senate Minority Leader Chuck Schumer called on Medicare to cover a vaccine for coronavirus. A vaccine for coronavirus is still being developed, with no current timetable for when one might be readily available for widespread distribution.


 

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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