If you have to seek treatment for COVID-19, the last thing you’ll want to worry about is whether your insurance will cover it. To take some of the stress out of protecting your health at this time, we’ve put together a guide to how public and private payers are handling the costs of COVID-19 services.
Please note that you should call your healthcare provider prior to testing to see if you meet the criteria for testing, as only people with active symptoms or known exposure to someone infected should be tested at this time.
As insurance coverage decisions are developing rapidly, the best way to know what your plan covers is to reach out to them directly.
If you have Medicare
According to Medicare.gov, the following services for COVID-19 are covered under Medicare.
- Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs. Please call your healthcare provider prior to testing to see if you meet the criteria for testing, as only people with active symptoms or known exposure to someone infected should be tested at this time.
- Medicare covers all medically necessary hospitalizations. This includes if you’re diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.
- At this time, there’s no vaccine for COVID-19. However, if one becomes available, it will be covered by all Medicare Prescription Drug Plans (Part D).
- Medicare has temporarily expanded its coverage of telehealth services to respond to the current Public Health Emergency. Medicare covers both “virtual check-ins” (brief, virtual services with your established provider where the communication isn’t related to a medical visit within the previous 7 days and doesn’t lead to a medical visit within the next 24 hours or soonest appointment available) as well as communication via online patient portals.
- Scammers may use the coronavirus national emergency to take advantage of people while they’re distracted. As always, guard your Medicare card like a credit card, check Medicare claims summary forms for errors, and if someone calls asking for your Medicare Number, hang up!
If you have Medicare Advantage
- If you have a Medicare Advantage Plan, you have access to these same benefits listed above for Medicare beneficiaries. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits beyond the ones described above. Check with your plan about your coverage and costs.
If you have Medicaid or CHIP
- Medicaid and CHIP coverage varies by state. You can find some information about coverage and benefits at this CMS page, or by reaching out to your state Medicaid provider.
If you have private insurance
More than 170 million people in the U.S. are covered by private health plans, and those plans cover many different benefits. To learn more about what is covered under your insurance plan, please contact your insurance company directly.
Here is what we can tell you about private insurance coverage, though we recommend confirming any guidance here with your health plan.
- Congress recently passed a new law, the Families First Coronavirus Response Act, that will require most private health plans to cover testing for the coronavirus with no cost sharing during the emergency period. Please call your healthcare provider prior to testing to see if you meet the criteria for testing, as only people with active symptoms or known exposure to someone infected should be tested at this time.
- At this time, there’s no vaccine for COVID-19. If one is developed, it may be covered with no cost sharing under the ACA. The U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, and other agencies are tasked with periodically reviewing and recommending preventive services to be covered under this requirement.
- There is no federal requirement for private plans to waive cost sharing for COVID-19-related treatment. While many private health insurers recently announced they will voluntarily waive cost sharing for testing, industry leaders have clarified that this waiver does not generally apply to treatment.
If you have questions about your health or you’re not feeling well, contact your healthcare provider by phone or visit their website to determine whether you should be seen in-person.
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